Provider Demographics
NPI:1316010051
Name:HANSON, CHERYL LYNN (LICENSEDPSYCHOLOGIST)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:L P
Mailing Address - Street 1:1128 IOWA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2242
Mailing Address - Country:US
Mailing Address - Phone:651-487-0440
Mailing Address - Fax:
Practice Address - Street 1:160 KELLOGG BLVD E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1420
Practice Address - Country:US
Practice Address - Phone:651-266-4094
Practice Address - Fax:651-266-4663
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4132103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist