Healthcare Provider Details

I. General information

NPI: 1962530808
Provider Name (Legal Business Name): SUSAN HOLLAND HANSEL AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S GREENLEAF ST SUITE 109
GURNEE IL
60031-5705
US

IV. Provider business mailing address

473 N HOWARD AVE
ELMHURST IL
60126-2022
US

V. Phone/Fax

Practice location:
  • Phone: 847-249-0167
  • Fax: 847-249-0717
Mailing address:
  • Phone: 630-533-3341
  • Fax: 847-249-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147-000311
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number147-000311
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number147-000311
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: