Individual
DR. MOLLIE MARIE HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2502 E EMPIRE, STE C MIDWEST REGIONAL PAIN CENTER, BLOOMINGTON, IL 61704
(309) 663-7220
(309) 664-6687
Mailing address
PO BOX 604, PSYCHOLOGY SPECIALISTS, BLOOMINGTON, IL 61702-0604
(309) 452-8330
(309) 452-9028
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112584
HEALTH ALLIANCE
IL
Enumeration date
07/28/2006
Last updated
07/08/2007
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