Provider Demographics
NPI:1750686804
Name:HANSON, KATLYN MARIE
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29821 COLVIN ST
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-0746
Mailing Address - Country:US
Mailing Address - Phone:541-247-4082
Mailing Address - Fax:541-247-5058
Practice Address - Street 1:29821 COLVIN ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444-0746
Practice Address - Country:US
Practice Address - Phone:541-247-4082
Practice Address - Fax:541-247-5058
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health