Healthcare Provider Details

I. General information

NPI: 1235066499
Provider Name (Legal Business Name): RYAN HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BARDIN RD
SALINAS CA
93905-2904
US

IV. Provider business mailing address

755 CORDOBA ST
SOLEDAD CA
93960-2578
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-5700
  • Fax:
Mailing address:
  • Phone: 408-710-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22689
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: