Provider Demographics
NPI:1689899338
Name:HANSON, JESSICA GWEN (CMT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:GWEN
Last Name:HANSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 WINNDALE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157
Mailing Address - Country:US
Mailing Address - Phone:770-443-3517
Mailing Address - Fax:
Practice Address - Street 1:500 NATHAN DEAN BULVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157
Practice Address - Country:US
Practice Address - Phone:770-445-6919
Practice Address - Fax:770-445-5699
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist