Provider Demographics
NPI:1093928517
Name:HANSON, PAMELA RAE (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:LSCSW
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6400 GLENWOOD ST
Mailing Address - Street 2:CLOVERLEAF BUILDING #4, SUITE 315
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4016
Mailing Address - Country:US
Mailing Address - Phone:913-558-9060
Mailing Address - Fax:913-677-5250
Practice Address - Street 1:6400 GLENWOOD ST
Practice Address - Street 2:CLOVERLEAF BUILDING #4, SUITE 315
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4016
Practice Address - Country:US
Practice Address - Phone:913-558-9060
Practice Address - Fax:913-677-5250
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS21531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS29162015OtherBLUE CROSS & BLUE SHIELD