Provider Demographics
NPI:1093862096
Name:HANSEN, DOUGLAS R (MSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 NE 55TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2254
Mailing Address - Country:US
Mailing Address - Phone:206-633-0939
Mailing Address - Fax:206-985-0410
Practice Address - Street 1:4026 NE 55TH ST STE B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2254
Practice Address - Country:US
Practice Address - Phone:206-633-0939
Practice Address - Fax:206-985-0410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker