Provider Demographics
NPI:1699094011
Name:HANSON, JESSICA LEIGH (MA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:BONERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:805 CENTURY DR STE 5
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3771
Mailing Address - Country:US
Mailing Address - Phone:563-587-9406
Mailing Address - Fax:
Practice Address - Street 1:805 CENTURY DR STE 5
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3771
Practice Address - Country:US
Practice Address - Phone:563-587-9406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
IA001537101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional