Individual
SUSAN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
207 LARKSPUR ST, PONDERAY, ID 83852-5011
(208) 255-3304
(208) 263-4198
Mailing address
207 LARKSPUR ST, PONDERAY, ID 83852-5011
(208) 255-3304
(208) 263-4198
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
02/26/2016
Last updated
02/26/2016
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