Individual
MRS. KATIE ANN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
305 S REGENCY DR, #1, BLOOMINGTON, IL 61701-4343
(309) 224-7560
Mailing address
305 S REGENCY DR, #1, BLOOMINGTON, IL 61701-4343
(309) 224-7560
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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