Individual
IAN JAYMES HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3000 MARKET ST NE STE 530, SALEM, OR 97301-1835
(503) 390-5637
Mailing address
951 REDHILL DR SE, SALEM, OR 97302-2616
(206) 321-4773
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
7706612
OR
Other
Enumeration date
07/02/2010
Last updated
07/02/2010
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