Individual
AUDREY JO HANSEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
205 HORTON, NORMAL, IL 61790-5120
(309) 438-5366
(309) 438-5559
Mailing address
205 HORTON, NORMAL, IL 61790-5120
(309) 438-5366
(309) 438-5559
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
09600175
IL
Other
Enumeration date
03/24/2006
Last updated
07/08/2007
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