Healthcare Provider Details

I. General information

NPI: 1710034392
Provider Name (Legal Business Name): JANINE B HANSEN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N MAIN ST SUITE 3
BOUNTIFUL UT
84010-6089
US

IV. Provider business mailing address

4623 MEADOW RD
MURRAY UT
84107-3934
US

V. Phone/Fax

Practice location:
  • Phone: 801-397-2100
  • Fax: 801-397-2131
Mailing address:
  • Phone: 801-792-0664
  • Fax: 801-397-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number359545-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: