Jessie Hansen

Primary specialty

SpecialistTaxonomy code 174400000X

License

14D2099042 Issued in IL

Practice address

541 Spruce Rd
Bolingbrook, IL 60440-2504

Phone

(630) 880-6523

Fax

(630) 929-8057

NPI assigned

Nov 13, 2015

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)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bolingbrook Urgent Care LLC

  • Urgent Care Clinic/Center
  • Bolingbrook, IL
  • NPI 1659642510
  NPD
• Liberty Mobile Labs Inc

  • Clinical Medical Laboratory
  • Bolingbrook, IL
  • NPI 1568949758
  NPD
• Hansen Lab Service Inc

  • Clinical Medical Laboratory
  • Bolingbrook, IL
  • NPI 1205259231
  NPD (past)

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

{
    "created_epoch": "1447372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447372800000",
    "number": "1992179972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 SPRUCE RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402504",
            "telephone_number": "630-880-6523",
            "fax_number": "630-929-8057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 SPRUCE RD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402504",
            "telephone_number": "630-880-6523",
            "fax_number": "630-929-8057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "JESSIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-13",
        "last_updated": "2015-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "14D2099042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE OF WAIVER CLIA",
            "identifier": "14D2099042",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Half Moon Holistic Clinic, LLC
• Amy Michelle Hanna, SPEECH/LANGUAGE PATH
• Hansen Lab Service Inc
• Donald Hansen, OWNER
• Donald Joseph Hansen, AMCA-4709
• Abigail Marie Happ
• Bianca Harenberg, LCSW
• Jatona Harris
• Tristan Harter, NCSP
• Sarah Sayed Hassan

• Specialist in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; 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.