Individual
MARY HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8TH AVENUE C ST E, SALT LAKE CITY, UT 84143-0001
(801) 408-3765
Mailing address
1495 S COUNTRYSIDE LN, HEBER CITY, UT 84032-3577
(435) 671-8149
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
9831386-4102
UT
Other
Enumeration date
07/11/2019
Last updated
07/11/2019
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