Provider Demographics
NPI:1376779991
Name:HANSEN, ERICA MARGARET (LSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:MARGARET
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 11TH AVE NW STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2297
Mailing Address - Country:US
Mailing Address - Phone:507-252-6985
Mailing Address - Fax:507-289-4524
Practice Address - Street 1:602 11TH AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2297
Practice Address - Country:US
Practice Address - Phone:507-252-6985
Practice Address - Fax:507-289-4524
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker