Provider Demographics
NPI:1174738074
Name:HANSEN, JENNIFER ELAINE (PHD LPC NCC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ELAINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHD LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2343
Mailing Address - Country:US
Mailing Address - Phone:307-745-9815
Mailing Address - Fax:307-745-8761
Practice Address - Street 1:50 N EISENHOWER AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-7340
Practice Address - Country:US
Practice Address - Phone:641-423-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001692101YM0800X
WY885101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health