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General NPI Number Information
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NPI Number | 1043016041
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Entity Type | Individual
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Provider Name | KASSIDY A HANSEN
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Gender | Female
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 449 EDGEWATER DR
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City | MORRIS
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State | IL
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Zip | 60450-8857
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Country | US
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Telephone | 815-600-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 25849 LORENZO RD
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City | WILMINGTON
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State | IL
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Zip | 60481-9329
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Country | US
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Telephone | 815-823-7395
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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