Provider Demographics
NPI:1558422121
Name:HANSEN, JOAN RENEE
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:RENEE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAC CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50583-1910
Mailing Address - Country:US
Mailing Address - Phone:712-662-3222
Mailing Address - Fax:
Practice Address - Street 1:322 S 13TH ST
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-1910
Practice Address - Country:US
Practice Address - Phone:712-662-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05801OtherLISW LICENSE
IA05801OtherLISW LICENSE