Provider Demographics
NPI:1407932072
Name:HANSON, JULIE ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
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 1:1880 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4085
Mailing Address - Country:US
Mailing Address - Phone:651-271-4512
Mailing Address - Fax:651-779-9734
Practice Address - Street 1:2213 7TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2807
Practice Address - Country:US
Practice Address - Phone:651-271-4512
Practice Address - Fax:651-779-9734
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical