Individual
MRS. BETHANY ANNE HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
425 SUMMIT ST, WILD ROSE, WI 54984-6804
(920) 622-4359
Mailing address
3555 WILLOW DR APT 106, PLOVER, WI 54467-3586
(608) 609-5024
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4614
WI
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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