Provider Demographics
NPI:1821540477
Name:HANSON, MELINDA L
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:L
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:PO BOX 2462
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2462
Mailing Address - Country:US
Mailing Address - Phone:303-570-9486
Mailing Address - Fax:
Practice Address - Street 1:20075 THUNDER RD E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-1110
Practice Address - Country:US
Practice Address - Phone:303-570-9486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services