Provider Demographics
NPI:1649457987
Name:HANSEN, ABIGAIL GUEVARA (PHD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GUEVARA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:16 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1228
Mailing Address - Country:US
Mailing Address - Phone:616-866-4830
Mailing Address - Fax:
Practice Address - Street 1:16 N MONROE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1228
Practice Address - Country:US
Practice Address - Phone:616-866-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30390Medicare PIN