Provider Demographics
NPI:1558503540
Name:HANSEN, SANDRA J (MS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E VIRGINIA AVE
Mailing Address - Street 2:STE 275
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1195
Mailing Address - Country:US
Mailing Address - Phone:602-264-4600
Mailing Address - Fax:602-264-7325
Practice Address - Street 1:3233 W PEORIA AVE
Practice Address - Street 2:STE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4614
Practice Address - Country:US
Practice Address - Phone:602-264-4600
Practice Address - Fax:602-264-7325
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0381101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional