Basic Information
| Provider Information | |||||||||
| NPI: | 1356571137 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | SUSHANNAH | ||||||||
| MiddleName: | WYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. SLP-CF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2334 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDER CITY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350103569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053299061 | ||||||||
| FaxNumber: | 2562153794 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
| FaxNumber: | 2059425884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2009 | ||||||||
| LastUpdateDate: | 07/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | AL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.