Basic Information
| Provider Information | |||||||||
| NPI: | 1881040962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1011 | ||||||||
| Address2: | |||||||||
| City: | SKAGWAY | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998401011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078430623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16941 NORTH EAGLE RIVER LOOP ROAD, SUITE 3 | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077265330 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2016 | ||||||||
| LastUpdateDate: | 05/09/2016 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.