Provider Demographics
NPI:1639775109
Name:HANSON, JOHN C (SUDP-T)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:HANSON
Suffix:
Gender:M
Credentials:SUDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 S NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-6448
Mailing Address - Country:US
Mailing Address - Phone:509-981-1766
Mailing Address - Fax:
Practice Address - Street 1:10305 E MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4220
Practice Address - Country:US
Practice Address - Phone:206-605-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)