Active NPI
Bruce R Hanson, MS CCC SLP
- Speech-Language Pathologist
- Moorhead, MN
National Provider Identifier
1073605697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 7237
- Practice address
- 1104 7TH Ave South
Msum Box 119
Moorhead, MN 56563-0001 - Phone
- (218) 477-4641
- Fax
- (218) 477-4392
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7237 | MN | Primary |
Addresses
Primary practice location
1104 7TH Ave South
Msum Box 119
Moorhead, MN 56563-0001
Mailing address
1104 7TH Ave South
Msum Box 119
Moorhead, MN 56563-0001
Phone (218) 477-5953
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 18427 | Other | ND | BCBS |
| 61B51HA | Other | MN | BCBS |
| 51834 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7237 | MN | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minnesota State Colleges & Universities | Past | Accepting new patients | |
| Minnesota State Colleges & Universities | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Speech-Language Pathologist
- Moorhead, MN
- NPI 1215000963
-
- Audiologist
- Moorhead, MN
- NPI 1558421404
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073605697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 7TH AVE SOUTH",
"address_2": "MSUM BOX 119",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565630001",
"telephone_number": "218-477-5953",
"fax_number": "218-477-4392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 7TH AVE SOUTH",
"address_2": "MSUM BOX 119",
"city": "MOORHEAD",
"state": "MN",
"postal_code": "565630001",
"telephone_number": "218-477-4641",
"fax_number": "218-477-4392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "BRUCE",
"middle_name": "R",
"credential": "MS CCC SLP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MN",
"license": "7237",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "18427",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "61B51HA",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "51834",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Moorhead, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.