Provider Demographics
NPI:1508999483
Name:HANSON, SUSAN CATHERINE (BHA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CATHERINE
Last Name:HANSON
Suffix:
Gender:F
Credentials:BHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0083
Mailing Address - Country:US
Mailing Address - Phone:907-883-5185
Mailing Address - Fax:907-883-4332
Practice Address - Street 1:MILEPOST 125 TOK CUT OFF
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-883-5185
Practice Address - Fax:907-883-4332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health