Provider Demographics
NPI:1104144542
Name:HANSEN, STEPHNIE
Entity type:Individual
Prefix:
First Name:STEPHNIE
Middle Name:
Last Name:HANSEN
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 1:309 E FARWELL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-8202
Mailing Address - Country:US
Mailing Address - Phone:509-465-8400
Mailing Address - Fax:150-946-5850
Practice Address - Street 1:309 E FARWELL RD STE 206
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8202
Practice Address - Country:US
Practice Address - Phone:509-465-8400
Practice Address - Fax:509-465-8500
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60065428225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist