Provider Demographics
NPI:1891466124
Name:LIEB-HANSON, ERIN RENEE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RENEE
Last Name:LIEB-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 1:7730 CARONDELET AVE
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3314
Mailing Address - Country:US
Mailing Address - Phone:844-502-7996
Mailing Address - Fax:
Practice Address - Street 1:722 STONEBRIDGE CENTER RD
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-2159
Practice Address - Country:US
Practice Address - Phone:217-282-9854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.014022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist