Individual
DR. BLAKE DARRELL HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1609 W 50 N, PLEASANT GROVE, UT 84062-3565
(801) 419-5899
Mailing address
1609 W 50 N, PLEASANT GROVE, UT 84062-3565
(801) 419-5899
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11235836-2506
UT
Other
Enumeration date
11/30/2017
Last updated
01/21/2021
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