MEDICARE: ALLYSIA MARIE HANSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1588528624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSIA MARIE HANSEN

Provider Business Mailing Address
First Line	:	382 NE 191ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-3899
Country	:	US
Telephone Number	:	651-431-6628
Fax Number	:	919-561-6612

Provider Business Practice Location Address
First Line	:	2829 N 90TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-5774
Country	:	US
Telephone Number	:	402-819-4059
Fax Number	:	919-561-6612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ ALLYSIA MARIE HANSEN ” Practice Location

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