Mollie Marie Hanson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Practice address

2502 E Empire
Ste C Midwest Regional Pain Center
Bloomington, IL 61704

Phone

(309) 663-7220

Fax

(309) 664-6687

NPI assigned

Jul 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1952315772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 604",
            "address_2": "PSYCHOLOGY SPECIALISTS",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617020604",
            "telephone_number": "309-452-8330",
            "fax_number": "309-452-9028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2502 E EMPIRE",
            "address_2": "STE C MIDWEST REGIONAL PAIN CENTER",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "61704",
            "telephone_number": "309-663-7220",
            "fax_number": "309-664-6687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSON",
        "first_name": "MOLLIE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "112584",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Ann Hansen
• Bert John Hanson
• Brian James Hanson, MA, CADC
• Jillian Michelle Hanson, MD
• Mark J Hanson, M.D.
• Kay Harbers, PT, OCS
• Timothy Robert Harbers, PT
• Joseph G Harman, M.D.
• Juliana Elizabeth Harms, LCSW ACSW
• Harold Ryan Pharmacy Inc (Ryan Pharmacy)

• Clinical Psychologist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.