Doctor Name: | DR. DAVID ROBERT HANSON |
NPI Number: | 1225103401 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSYD |
License Number: | |
Business Practice Address: | 21 N Skokie Highway Suite 203 Lake Bluff, IL - 60044 |
Business Phone Number: | 8472956141 |
Business Fax Number: | 8472956176 |
Mailing Address: | 21 N Skokie Highway, Suite 203 LAKE BLUFF |
State: | IL |
Postal Code: | 60044 |
Phone Number: | 8472956141 |
Fax Number: | 8472956176 |
NPI Enumeration Date: | 11/22/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |