Healthcare Provider Details

I. General information

NPI: 1104319110
Provider Name (Legal Business Name): VICTORIA HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 COVE RD
BROOKINGS OR
97415-2520
US

IV. Provider business mailing address

18716 GARDNER RIDGE RD
BROOKINGS OR
97415-8214
US

V. Phone/Fax

Practice location:
  • Phone: 541-469-0222
  • Fax: 541-469-0228
Mailing address:
  • Phone: 541-226-1386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: