Provider Demographics
NPI:1326144791
Name:HANSON, DEBORAH L (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:HANSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 3RD ST NE STE 1
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3006
Mailing Address - Country:US
Mailing Address - Phone:701-662-1911
Mailing Address - Fax:701-662-4770
Practice Address - Street 1:501 3RD ST NE STE 1
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-3006
Practice Address - Country:US
Practice Address - Phone:701-662-1911
Practice Address - Fax:701-662-4770
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19171Medicaid
ND26661OtherBCBS OF ND