Provider Demographics
NPI:1528129806
Name:HANSEN, DAWN (SLP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 HAZEL DELL RD
Mailing Address - Street 2:
Mailing Address - City:CORRALITOS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0313
Mailing Address - Country:US
Mailing Address - Phone:408-847-7900
Mailing Address - Fax:408-847-3757
Practice Address - Street 1:7888 WREN AVE STE C131
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4965
Practice Address - Country:US
Practice Address - Phone:408-847-7900
Practice Address - Fax:408-847-3757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5621235Z00000X
CASP5621235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist