Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LP2664 | MN |
NPI | 1194825711 |
---|---|
Provider Name | Ronald H Hanson |
First Address | Plymouth, MN 55447-1697 |
Second Address | Plymouth, MN 55447-1697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |