Healthcare Provider Details

I. General information

NPI: 1972002657
Provider Name (Legal Business Name): HEATHER HANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5073 5TH ST
BOULDER CO
80304-4747
US

IV. Provider business mailing address

3980 BROADWAY ST., STE. 103 BOX 179
BOULDER CO
80304
US

V. Phone/Fax

Practice location:
  • Phone: 130-354-9936
  • Fax:
Mailing address:
  • Phone: 303-720-1424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: