Provider Demographics
NPI:1386706232
Name:HANSEN, JOAN ELLEN (MS CCC SP)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELLEN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 S 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219
Mailing Address - Country:US
Mailing Address - Phone:414-545-4672
Mailing Address - Fax:
Practice Address - Street 1:2895 S MOORLAND ROAD
Practice Address - Street 2:NEW BERLIN THERAPIES
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151
Practice Address - Country:US
Practice Address - Phone:262-782-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist