Provider Demographics
NPI:1326228271
Name:HANSEN, SUSAN GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:HANSEN
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 1:11155 FAIRBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5600
Mailing Address - Country:US
Mailing Address - Phone:314-692-8518
Mailing Address - Fax:
Practice Address - Street 1:11155 FAIRBOROUGH CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-5600
Practice Address - Country:US
Practice Address - Phone:314-692-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040330201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical