Individual
K. GENE HANSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3809 W 6200 S, KEARNS, UT 84118-3725
(801) 963-4209
(801) 963-4299
Mailing address
1976 WASATCH DR, SALT LAKE CITY, UT 84108-3326
(801) 474-3292
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
831120242501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
U006 107021000101
INTERMOUNTAIN HEALTH CARE
UT
01
—
U009 942938348
CHAMPUS
UT
Enumeration date
12/22/2005
Last updated
07/08/2007
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