Basic Information
| Provider Information | |||||||||
| NPI: | 1578227898 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANLY | ||||||||
| FirstName: | ALESSANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49132 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809499132 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 N 8TH ST | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812123307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192753968 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2021 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HAD.0000444 | CO | N | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 237700000X | 444 | CO | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
ID Information
| ID | Type | State | Issuer | Description | HAD.0000444 | 01 | CO | STATE LICENSE | OTHER |