Provider Demographics
NPI:1710258892
Name:HANSON, CHARLES W (MA, LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:HANSON
Suffix:
Gender:M
Credentials:MA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2902
Mailing Address - Country:US
Mailing Address - Phone:913-327-9038
Mailing Address - Fax:913-334-9999
Practice Address - Street 1:4914 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2902
Practice Address - Country:US
Practice Address - Phone:913-327-9038
Practice Address - Fax:913-334-9999
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0037681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical