Provider Demographics
NPI:1578683256
Name:HANSEN, LINDA K (MA, LP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:K
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10636 ALISON WAY
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-5472
Mailing Address - Country:US
Mailing Address - Phone:651-454-4339
Mailing Address - Fax:
Practice Address - Street 1:1600 HIGHWAY 55
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2368
Practice Address - Country:US
Practice Address - Phone:651-438-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist