Provider Demographics
NPI:1124741624
Name:HANSON, REBECKA (MS, ACMHC, RDN)
Entity type:Individual
Prefix:
First Name:REBECKA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, ACMHC, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 NORTH 50 WEST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 NORTH 50 WEST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074
Practice Address - Country:US
Practice Address - Phone:801-231-6986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2024-11-08
Deactivation Date:2022-11-19
Deactivation Code:
Reactivation Date:2022-12-28
Provider Licenses
StateLicense IDTaxonomies
UT81849526009101YM0800X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered