Provider Demographics
NPI:1184657710
Name:HANSLOW, JACQUE DEANNE (LMHC)
Entity Type:Individual
Prefix:
First Name:JACQUE
Middle Name:DEANNE
Last Name:HANSLOW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JACQUE
Other - Middle Name:DEANNE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1205 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-1418
Mailing Address - Country:US
Mailing Address - Phone:765-429-8714
Mailing Address - Fax:
Practice Address - Street 1:427 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1189
Practice Address - Country:US
Practice Address - Phone:765-420-0938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001759A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health