Provider Demographics
NPI:1457548737
Name:HANSEN, DEBORAH RUDDY (MA)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:RUDDY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 UNIVERSAL WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1455
Mailing Address - Country:US
Mailing Address - Phone:517-782-8714
Mailing Address - Fax:517-782-8705
Practice Address - Street 1:6 UNIVERSAL WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1455
Practice Address - Country:US
Practice Address - Phone:517-782-8714
Practice Address - Fax:517-782-8705
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical