Healthcare Provider Details

I. General information

NPI: 1861307506
Provider Name (Legal Business Name): ELIZABETH KATHRYN HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIZZY KATHRYN HANSON

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 W 17TH ST
GREELEY CO
80634-6005
US

IV. Provider business mailing address

2313 W 17TH ST
GREELEY CO
80634-6005
US

V. Phone/Fax

Practice location:
  • Phone: 720-491-8171
  • Fax: 720-367-0043
Mailing address:
  • Phone: 720-491-8171
  • Fax: 720-367-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: