Provider Demographics
NPI:1265657670
Name:HANSON, COLLEEN M (LCSW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 STATE ROUTE 53 STE B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3394
Mailing Address - Country:US
Mailing Address - Phone:630-524-4000
Mailing Address - Fax:630-524-2311
Practice Address - Street 1:6040 STATE ROUTE 53 STE B
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3394
Practice Address - Country:US
Practice Address - Phone:630-524-4000
Practice Address - Fax:630-524-2311
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490103281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBCBSOther022-27624