Provider Demographics
NPI:1720397201
Name:HANSEN, RONNIE LOUISE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:LOUISE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:LOUISE
Other - Last Name:MORELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 SW 57TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4480
Mailing Address - Country:US
Mailing Address - Phone:541-609-0462
Mailing Address - Fax:
Practice Address - Street 1:1229 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370
Practice Address - Country:US
Practice Address - Phone:541-609-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR78421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical