Healthcare Provider Details

I. General information

NPI: 1023373917
Provider Name (Legal Business Name): TERI JO HANSEN LMT, NBCHWC, CMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2012
Last Update Date: 03/12/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 W BAXTER DR
SOUTH JORDAN UT
84095-8506
US

IV. Provider business mailing address

6246 W SPRAY LAKE DR
WEST JORDAN UT
84081-5613
US

V. Phone/Fax

Practice location:
  • Phone: 801-618-9750
  • Fax:
Mailing address:
  • Phone: 801-618-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA3198092
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberM.S.
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberM.S.
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License NumberM.S.
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5484605-4701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: