Provider Demographics
NPI:1225166135
Name:HAKANSON, TRACI LYN (LISCW)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LYN
Last Name:HAKANSON
Suffix:
Gender:F
Credentials:LISCW
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:LYN
Other - Last Name:WEISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LICSW
Mailing Address - Street 1:17439 ISLETON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9693
Mailing Address - Country:US
Mailing Address - Phone:612-280-3048
Mailing Address - Fax:
Practice Address - Street 1:301 FULLER ST S
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1322
Practice Address - Country:US
Practice Address - Phone:612-280-3048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9015-1231041C0700X
MN15625104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical