Healthcare Provider Details

I. General information

NPI: 1770446429
Provider Name (Legal Business Name): JEFFREY J HANSEN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 BROADWAY ST
VANCOUVER WA
98663-3226
US

IV. Provider business mailing address

2215 BROADWAY ST
VANCOUVER WA
98663-3226
US

V. Phone/Fax

Practice location:
  • Phone: 360-906-7156
  • Fax: 360-696-3658
Mailing address:
  • Phone: 360-906-7156
  • Fax: 360-696-3658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY JON HANSEN
Title or Position: OWNER
Credential: MD
Phone: 503-504-5700