Provider Demographics
NPI:1518183813
Name:HANSEN, DENNIS A (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 E 1200 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-5449
Mailing Address - Country:US
Mailing Address - Phone:801-226-8223
Mailing Address - Fax:801-227-5040
Practice Address - Street 1:55 S 500 E
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1918
Practice Address - Country:US
Practice Address - Phone:435-675-3226
Practice Address - Fax:435-654-0309
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT127234-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical