Provider Demographics
NPI:1346653847
Name:HANSON, KRISTA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W THOMAS RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4419
Mailing Address - Country:US
Mailing Address - Phone:602-406-3671
Mailing Address - Fax:
Practice Address - Street 1:222 W THOMAS RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4419
Practice Address - Country:US
Practice Address - Phone:602-406-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4483103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist