Provider Demographics
NPI:1710034392
Name:HANSEN, JANINE B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:B
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3934
Mailing Address - Country:US
Mailing Address - Phone:801-792-0664
Mailing Address - Fax:801-397-2131
Practice Address - Street 1:1325 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6089
Practice Address - Country:US
Practice Address - Phone:801-397-2100
Practice Address - Fax:801-397-2131
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359545-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical