Provider Demographics
NPI:1134318207
Name:HANSEN, SUSAN M (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W GRAVES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-2306
Mailing Address - Country:US
Mailing Address - Phone:509-466-6106
Mailing Address - Fax:509-466-2925
Practice Address - Street 1:14 W GRAVES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-2306
Practice Address - Country:US
Practice Address - Phone:509-466-6106
Practice Address - Fax:509-466-2925
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist