Shelley K Hansen, Lsw, Ma, Lp, Llc | |
105 East Fourth Street Suite 302 Northfield MN 55057-2050 | |
(612) 532-6741 | |
Not Available |
Full Name | Shelley K Hansen, Lsw, Ma, Lp, Llc |
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Speciality | Psychologist |
Location | 105 East Fourth Street, Northfield, Minnesota |
Authorized Official Name and Position | Shelley Kay Hansen (OWNER) |
Authorized Official Contact | 6125326741 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Shelley K Hansen, Lsw, Ma, Lp, Llc 105 East Fourth Street Suite 302 Northfield MN 55057-2050 Ph: (612) 532-6741 | Shelley K Hansen, Lsw, Ma, Lp, Llc 105 East Fourth Street Suite 302 Northfield MN 55057-2050 Ph: (612) 532-6741 |
NPI Number | 1396084901 |
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Provider Enumeration Date | 02/04/2013 |
Last Update Date | 04/02/2014 |
Medicare PECOS PAC ID | 6305074824 |
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Medicare Enrollment ID | O20140108000646 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396084901 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | LP3954 (Minnesota) | Primary |
1041C0700X | Social Worker - Clinical | LSW5063 (Minnesota) | Secondary |
Provider Name | Shelley K Hansen |
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Provider Type | Practitioner - Psychologist Billing Independently |
Provider Identifiers | NPI Number: 1740343532 PECOS PAC ID: 1759519275 Enrollment ID: I20230310000136 |
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