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General NPI Number Information
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NPI Number | 1457799736
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Entity Type | Individual
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Provider Name | EMILY JEAN HANSON
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Gender | Female
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1624 SANTA CLARA DR STE 110
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City | ROSEVILLE
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State | CA
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Zip | 95661-3553
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Country | US
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Telephone | 916-467-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 344 CIRCUIT DR
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City | ROSEVILLE
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State | CA
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Zip | 95678-2152
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Country | US
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Telephone | 775-544-4607
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 95369
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License Number State | CA
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