Provider Demographics
NPI:1528615671
Name:HANSEN HOME SPEECH, LLC
Entity type:Organization
Organization Name:HANSEN HOME SPEECH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CCC, MS
Authorized Official - Phone:661-904-8811
Mailing Address - Street 1:8981 N SKYE LOOP
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6224
Mailing Address - Country:US
Mailing Address - Phone:661-904-8811
Mailing Address - Fax:
Practice Address - Street 1:8981 N SKYE LOOP
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6224
Practice Address - Country:US
Practice Address - Phone:661-904-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech