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General NPI Number Information
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NPI Number | 1104816347
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Entity Type | Individual
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Provider Name | JODY HANSEN M.A., L.P.C., N.C.C.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 14500 S OUTER 40 RD STE 108
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5736
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Country | US
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Telephone | 314-488-8798
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Fax |
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Provider Business Mailing Address
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Address Line | 345 REMINGTON WAY DR
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City | BALLWIN
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State | MO
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Zip | 63021-6379
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Country | US
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Telephone | 636-230-9258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2001014183
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License Number State | MO
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