Provider Demographics
NPI:1962530808
Name:HANSEL, SUSAN HOLLAND (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HOLLAND
Last Name:HANSEL
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2022
Mailing Address - Country:US
Mailing Address - Phone:630-533-3341
Mailing Address - Fax:847-249-0717
Practice Address - Street 1:222 S GREENLEAF ST
Practice Address - Street 2:SUITE 109
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5705
Practice Address - Country:US
Practice Address - Phone:847-249-0167
Practice Address - Fax:847-249-0717
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000311231H00000X, 231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0004921745OtherBCBS
IL363036298OtherTAX ID NUMBER