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NPI Code Detail

MEDICARE: K. GENE HANSEN PH.D.

MEDICARE: K. GENE HANSEN PH.D.
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
1103TC0700XClinical Psychologist831120242501UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1U009 942938348OTHERUTCHAMPUS
2U006 107021000101OTHERUTINTERMOUNTAIN HEALTH CARE

General Provider Information

NPI Number : 1760469555
Entity Type Code : Individual
Provider Name (Legal Business Name) : K. GENE HANSEN PH.D.
Provider Business Mailing Address
First Line : 1976 WASATCH DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-3326
Country : US
Telephone Number : 801-474-3292
Fax Number :
Provider Business Practice Location Address
First Line : 3809 W 6200 S
Second Line :
City : KEARNS
State : UT
Zip : 84118-3725
Country : US
Telephone Number : 801-963-4209
Fax Number : 801-963-4299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 07/08/2007

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