Provider Demographics
NPI:1477087716
Name:KERRI HANSON LICSW LLC
Entity Type:Organization
Organization Name:KERRI HANSON LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:509-263-2341
Mailing Address - Street 1:PO BOX 1941
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-1941
Mailing Address - Country:US
Mailing Address - Phone:509-263-2341
Mailing Address - Fax:509-443-6197
Practice Address - Street 1:5915 S REGAL ST STE 304
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-6970
Practice Address - Country:US
Practice Address - Phone:509-263-2341
Practice Address - Fax:509-443-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60103013251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health