MEDICARE: MARIANNE HANSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	OH 4060	OH

General Provider Information

NPI Number	:	1407276868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNE HANSEN

Provider Business Mailing Address
First Line	:	2601 PARKLAWN DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45440-1251
Country	:	US
Telephone Number	:	937-499-1790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 PARKLAWN DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45440-1251
Country	:	US
Telephone Number	:	937-499-1790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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Directions to “ MARIANNE HANSEN ” Practice Location

Language	Start Address	Practice Location

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