Provider Demographics
NPI:1699898130
Name:HANSON, KESTREL MATI (MA)
Entity type:Individual
Prefix:
First Name:KESTREL
Middle Name:MATI
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WEAVER DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9668
Mailing Address - Country:US
Mailing Address - Phone:303-449-2217
Mailing Address - Fax:303-786-9247
Practice Address - Street 1:2833 N BROADWAY
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304
Practice Address - Country:US
Practice Address - Phone:303-449-2217
Practice Address - Fax:303-786-9247
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health