Provider Demographics
NPI:1689053332
Name:HANSEN, CATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BRIGHTON WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7726
Mailing Address - Country:US
Mailing Address - Phone:304-553-8752
Mailing Address - Fax:
Practice Address - Street 1:60 GALLERY RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8839
Practice Address - Country:US
Practice Address - Phone:304-553-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPROVISONAL LICENSECF235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist