Basic Information
| Provider Information | |||||||||
| NPI: | 1003151481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | KANDYCE | ||||||||
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| Credential: | M.S,CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30627 82ND AVE NW | ||||||||
| Address2: | |||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982925815 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 26920 PIONEER HWY | ||||||||
| Address2: | |||||||||
| City: | STANWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982929548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606291360 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL0003206 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.