Provider Demographics
NPI:1104006378
Name:HANSEN, KRISTINE RUTH (CADC II)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:RUTH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:641 S. LINCOLN
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-0901
Mailing Address - Country:US
Mailing Address - Phone:503-739-2788
Mailing Address - Fax:
Practice Address - Street 1:1325 N HOLLADAY DR
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-7131
Practice Address - Country:US
Practice Address - Phone:503-738-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR070660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)