Individual
JEANA M HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1514 FALCON DR, AMMON, ID 83406-5823
(208) 604-4759
Mailing address
1514 FALCON DR, AMMON, ID 83406-5823
(208) 604-4759
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-3427
ID
Other
Enumeration date
07/25/2018
Last updated
07/25/2018
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