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General NPI Number Information
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NPI Number | 1598986176
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Entity Type | Individual
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Provider Name | LESLIE R HANSON
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6679 EDWARDSVILLE CROSSING DRIVE
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City | EDWARDSVILLE
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State | IL
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Zip | 62025
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Country | US
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Telephone | 618-659-2878
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Fax | 618-659-2921
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Provider Business Mailing Address
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Address Line | 255 WINCHESTER PLACE
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City | FAAIRVIEW HEIGHTS
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State | IL
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Zip | 62208
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Country | US
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Telephone |
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 2915
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License Number State | IL
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