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NPI Code Detail

MEDICARE: ALLYSON HANSEN NYSTROM MA CCC-SLP

MEDICARE: ALLYSON HANSEN NYSTROM MA CCC-SLP
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
1235Z00000XSpeech-Language Pathologist528355MN

General Provider Information

NPI Number : 1649903444
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLYSON HANSEN NYSTROM MA CCC-SLP
Provider Business Mailing Address
First Line : 1891 STATION PKWY NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-3341
Country : US
Telephone Number : 763-755-4275
Fax Number :
Provider Business Practice Location Address
First Line : 1891 STATION PKWY NW
Second Line :
City : ANDOVER
State : MN
Zip : 55304-3341
Country : US
Telephone Number : 763-755-4275
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2022
Last Update Date : 02/13/2026

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