Provider Demographics
NPI:1003956947
Name:HANSEN, CHERYL BLOCK (LICSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BLOCK
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10486 90TH ST NE
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-8648
Mailing Address - Country:US
Mailing Address - Phone:320-796-5197
Mailing Address - Fax:
Practice Address - Street 1:502 2ND ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3337
Practice Address - Country:US
Practice Address - Phone:320-235-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical