Provider Demographics
NPI:1235350612
Name:HANSEN, DINA F (MA)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:F
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NW GILMAN BLVD
Mailing Address - Street 2:NO. 2105
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5394
Mailing Address - Country:US
Mailing Address - Phone:425-891-9381
Mailing Address - Fax:425-254-3402
Practice Address - Street 1:1621 114TH AVE SE
Practice Address - Street 2:SUITE 221
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6956
Practice Address - Country:US
Practice Address - Phone:425-890-1938
Practice Address - Fax:425-254-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009036103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral