Provider Demographics
NPI:1043588874
Name:HANSEN, AMY L (LCPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W ALEXANDER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1510
Mailing Address - Country:US
Mailing Address - Phone:309-310-2613
Mailing Address - Fax:309-671-0253
Practice Address - Street 1:2900 W HEADING AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4868
Practice Address - Country:US
Practice Address - Phone:309-636-7601
Practice Address - Fax:309-671-0253
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional