Individual
JENNIFER HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2065 W RIVERSTONE DR, SUITE 203, COEUR D ALENE, ID 83814-5699
(208) 765-1075
Mailing address
2065 W RIVERSTONE DR, SUITE 203, COEUR D ALENE, ID 83814-5699
(208) 765-1075
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
30150
ID
Other
Enumeration date
08/04/2009
Last updated
08/04/2009
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