Provider Demographics
NPI:1053658393
Name:HANSEN, TERAH APPEL ANDERSON (MS, CGC, LGC)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:APPEL ANDERSON
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS, CGC, LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3761
Mailing Address - Country:US
Mailing Address - Phone:509-575-8160
Mailing Address - Fax:509-577-5088
Practice Address - Street 1:2903 W. WALNUT
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-575-8160
Practice Address - Fax:509-577-5088
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAGT60316048170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1306883228Medicaid