Provider Demographics
NPI:1578160693
Name:HANSON, JOY A'LISA
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:A'LISA
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:A'LISA
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1140 W 1130 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2888
Mailing Address - Country:US
Mailing Address - Phone:385-227-8653
Mailing Address - Fax:
Practice Address - Street 1:1140 W. 1130 S.
Practice Address - Street 2:BUILDING B
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2888
Practice Address - Country:US
Practice Address - Phone:385-227-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician