Healthcare Provider Details

I. General information

NPI: 1750108155
Provider Name (Legal Business Name): BRITTANY JEAN HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 W WAYLEND ST
IDAHO FALLS ID
83402-1305
US

IV. Provider business mailing address

274 N MAIN ST
LOGAN UT
84321-3915
US

V. Phone/Fax

Practice location:
  • Phone: 360-521-9204
  • Fax:
Mailing address:
  • Phone: 435-213-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14225696-3502
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: