| Doctor Name: | MARY MARIE HANSEN |
| NPI Number: | 1730500950 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC-ALP |
| License Number: | 14072042 |
| Business Practice Address: | 107 E Beckert Rd New London, WI - 549612509 |
| Business Phone Number: | 9209825354 |
| Business Fax Number: | |
| Mailing Address: | N3936 Washington Ave Apt 4, FREEDOM |
| State: | WI |
| Postal Code: | 541306901 |
| Phone Number: | 6053215378 |
| Fax Number: | |
| NPI Enumeration Date: | 12/16/2013 |
| NPI Last Update Date: | 12/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 14072042 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |