Provider Demographics
NPI:1952606709
Name:HANSEN, MARIE (MS)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-3876
Mailing Address - Country:US
Mailing Address - Phone:262-547-2123
Mailing Address - Fax:262-547-6204
Practice Address - Street 1:1451 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3876
Practice Address - Country:US
Practice Address - Phone:262-547-2123
Practice Address - Fax:262-547-6204
Is Sole Proprietor?:No
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI79-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist