Provider Demographics
NPI:1467878728
Name:HAWSEN, KELLY JO (MA, LPC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:HAWSEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0283
Mailing Address - Country:US
Mailing Address - Phone:218-370-8773
Mailing Address - Fax:218-387-2248
Practice Address - Street 1:1910 W HIGHWAY 61
Practice Address - Street 2:BOX 283
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-7508
Practice Address - Country:US
Practice Address - Phone:218-370-8773
Practice Address - Fax:218-387-2248
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN00785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1629482112OtherSTEPS OF CHANGE LLC