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General NPI Number Information
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NPI Number | 1104493238
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Entity Type | Individual
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Provider Name | ABIGAIL JANE HANSEN M.S., CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 2325 OHIO PKWY
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City | ROCKFORD
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State | IL
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Zip | 61108-7514
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Country | US
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Telephone | 815-229-2840
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Fax |
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Provider Business Mailing Address
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Address Line | 600 ARDMORE TER
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3318
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Country | US
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Telephone | 847-997-4568
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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 | 146015720
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License Number State | IL
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