Healthcare Provider Details

I. General information

NPI: 1487294575
Provider Name (Legal Business Name): SONJA A HANSON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 S VINE ST
MURRAY UT
84107-7746
US

IV. Provider business mailing address

5411 S VINE ST
MURRAY UT
84107-7746
US

V. Phone/Fax

Practice location:
  • Phone: 801-905-1619
  • Fax:
Mailing address:
  • Phone:
  • 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: SONJA A HANSON
Title or Position: OWNER
Credential:
Phone: 801-201-1627