Corynn Hanson, M.S., CCC-SLP

Key facts

NPI

1144698952

Entity type

Individual (NPI type 1)

Primary specialty

Speech-Language Pathologist 235Z00000X

License

146012340 (IL)

Practice address

11971 Wagon Wheel Rd
Rockton, IL 61072-3322

Phone

(815) 624-2615

NPI assigned

Sep 10, 2015

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Winnebago Co SP Ed Coop Local Education Agency (LEA) · Rockton, IL · NPI 1730381294
  NPD

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Master of Science

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 8, 2020.

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586304000000",
    "number": "1144698952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11971 WAGON WHEEL RD",
            "city": "ROCKTON",
            "state": "IL",
            "postal_code": "610723322",
            "telephone_number": "608-347-8524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11971 WAGON WHEEL RD",
            "city": "ROCKTON",
            "state": "IL",
            "postal_code": "610723322",
            "telephone_number": "815-624-2615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2400 N Rockton Ave",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "IL",
            "postal_code": "611033655",
            "country_code": "US",
            "telephone_number": "815-971-5022 x5036",
            "fax_number": "815-971-9809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANSON",
        "first_name": "CORYNN",
        "name_prefix": "Ms.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-10",
        "last_updated": "2020-04-08",
        "certification_date": "2020-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146012340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Rockton, IL · Speech-Language Pathologist in Illinois