MEDICARE: DR. MARY CREER 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
1	103T00000X	Psychologist	471	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861416760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY CREER HANSEN PH.D.

Provider Business Mailing Address
First Line	:	803 S PEARL ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-4221
Country	:	US
Telephone Number	:	303-980-8111
Fax Number	:	303-722-0209

Provider Business Practice Location Address
First Line	:	777 S WADSWORTH BLVD
Second Line	:	4-170
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4300
Country	:	US
Telephone Number	:	303-980-8111
Fax Number	:	303-722-0209

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	02/13/2014

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