Provider Demographics
NPI:1588439210
Name:HANSEN, HAIDYN
Entity type:Individual
Prefix:
First Name:HAIDYN
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 1:3176 WATERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-1629
Mailing Address - Country:US
Mailing Address - Phone:775-313-6680
Mailing Address - Fax:
Practice Address - Street 1:10345 PROFESSIONAL CIR STE 125
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-3100
Practice Address - Country:US
Practice Address - Phone:775-332-8332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician