Provider Demographics
NPI:1255664322
Name:HANSON, CHRISTINE A (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2846 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-3771
Mailing Address - Country:US
Mailing Address - Phone:262-245-5608
Mailing Address - Fax:262-245-5648
Practice Address - Street 1:N2846 STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-3771
Practice Address - Country:US
Practice Address - Phone:262-245-5608
Practice Address - Fax:262-245-5648
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI3178-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid