Provider Demographics
NPI:1821762899
Name:HANLEY, LAURA MARTHA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARTHA
Last Name:HANLEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARTHA
Other - Last Name:RYDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:922 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2935
Mailing Address - Country:US
Mailing Address - Phone:507-338-1320
Mailing Address - Fax:
Practice Address - Street 1:922 10TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2935
Practice Address - Country:US
Practice Address - Phone:507-338-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN291351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical