MEDICARE: AMANDA ELAINE HANSEN B.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant
2	235Z00000X	Speech-Language Pathologist	SP-3128	NV
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1023367646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ELAINE HANSEN B.S.

Provider Business Mailing Address
First Line	:	650 EAST AZURE AVE.
Second Line	:	#3040
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-9016
Country	:	US
Telephone Number	:	509-551-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N BUFFALO DR UNIT 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3637
Country	:	US
Telephone Number	:	702-979-4268
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	09/15/2021

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Directions to “ AMANDA ELAINE HANSEN B.S.” Practice Location

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