Healthcare Provider Details

I. General information

NPI: 1003748294
Provider Name (Legal Business Name): KIMBERLYANN HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 MONTGOMERY AVE STE 2
PENN VALLEY PA
19072-1938
US

IV. Provider business mailing address

204 E SALAIGNAC ST APT A1
PHILADELPHIA PA
19128-3722
US

V. Phone/Fax

Practice location:
  • Phone: 412-242-8443
  • Fax:
Mailing address:
  • Phone: 484-844-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: