Individual
JACLYN ROSE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 906-4785
Mailing address
W3663 TAYNETTE CIR, MALONE, WI 53049-1608
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2988-19
WI
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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