Provider Demographics
NPI:1982114104
Name:HANSEN, CORTNEY CHRISTINE (SSW)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:CHRISTINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:SSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 W 11300 N
Mailing Address - Street 2:
Mailing Address - City:DEWEYVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84309-9719
Mailing Address - Country:US
Mailing Address - Phone:385-231-3945
Mailing Address - Fax:
Practice Address - Street 1:440 W 600 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-2400
Practice Address - Country:US
Practice Address - Phone:435-257-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1982114104Medicaid