Healthcare Provider Details

I. General information

NPI: 1093563983
Provider Name (Legal Business Name): ELIZABETH LYNNE HANSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 NEWBURY ST # 5
BOSTON MA
02115-2727
US

IV. Provider business mailing address

66 PLAIN DR
STOUGHTON MA
02072-3963
US

V. Phone/Fax

Practice location:
  • Phone: 617-463-9342
  • Fax:
Mailing address:
  • Phone: 508-562-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP100600
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: