Provider Demographics
NPI:1114045481
Name:BISANZ, DENISE HANNA (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:HANNA
Last Name:BISANZ
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 W 44TH
Mailing Address - Street 2:#200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1032
Mailing Address - Country:US
Mailing Address - Phone:763-520-4490
Mailing Address - Fax:952-922-1980
Practice Address - Street 1:3919 W 44TH
Practice Address - Street 2:#200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1032
Practice Address - Country:US
Practice Address - Phone:763-520-4490
Practice Address - Fax:952-922-1980
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN09919103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist