Basic Information
| Provider Information | |||||||||
| NPI: | 1871750935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.S. CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 683 FARM LAKE DR | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299105874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433046259 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 29 PLANTATION PARK DR | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299109001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156999 | ||||||||
| FaxNumber: | 8438156998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 4181 | SC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SA1093 | 05 | SC | MEDICAID |