Individual
MARY MARIE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-ALP
Contact information
Practice address
107 E BECKERT RD, NEW LONDON, WI 54961-2509
(920) 982-5354
Mailing address
N3936 WASHINGTON AVE APT 4, FREEDOM, WI 54130-6901
(605) 321-5378
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14072042
WI
Other
Enumeration date
12/16/2013
Last updated
12/16/2013
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