Basic Information
| Provider Information | |||||||||
| NPI: | 1780087981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5004 45TH AVE S | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981182310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609019423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12040 98TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980344290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256583016 | ||||||||
| FaxNumber: | 4256583017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2014 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CG60511035 | WA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.