Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1185 | WI |
Y | 103T00000X | Psychologist | 1185 | WI |
NPI | 1003860610 |
---|---|
Provider Name | Ms. Patricia Ann Hanson |
First Address | Madison, WI 53719-2092 |
Second Address | Madison, WI 53719-2092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39047000 | (05) | WI |