Individual
SCOTT HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(219) 263-3141
Mailing address
8252 N WAYNE DR, HAYDEN, ID 83835-5029
(219) 263-3141
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
DDA-999
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DDA-999
—
ID
Enumeration date
11/18/2014
Last updated
10/20/2016
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