MEDICARE: NATALIE SARA HANSEN 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
1	235Z00000X	Speech-Language Pathologist	21247	CA

General Provider Information

NPI Number	:	1790077055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE SARA HANSEN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	18171 MANDARIN LN APT A
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-3445
Country	:	US
Telephone Number	:	714-715-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 PLUMOSA DR
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-2322
Country	:	US
Telephone Number	:	714-986-7210
Fax Number	:

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	04/17/2020

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