Healthcare Provider Details

I. General information

NPI: 1629337464
Provider Name (Legal Business Name): KATHLEEN ANNE HANLEY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 MAIN ST
MANSON IA
50563-5160
US

IV. Provider business mailing address

1427 WILLIAMS DR
FORT DODGE IA
50501-7557
US

V. Phone/Fax

Practice location:
  • Phone: 712-469-3908
  • Fax:
Mailing address:
  • Phone: 708-269-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0001811
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number001811
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: