Healthcare Provider Details

I. General information

NPI: 1275458770
Provider Name (Legal Business Name): LAURA HANSEN M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N ROCHESTER RD
ROCHESTER HILLS MI
48306-1052
US

IV. Provider business mailing address

500 OLD PERCH RD
ROCHESTER HILLS MI
48309-2142
US

V. Phone/Fax

Practice location:
  • Phone: 248-270-0373
  • Fax:
Mailing address:
  • Phone: 248-270-0373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101004931
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: