Provider Demographics
NPI:1831480094
Name:SB HANSON LCSW, LLC
Entity Type:Organization
Organization Name:SB HANSON LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-488-0603
Mailing Address - Street 1:6015 DURAND AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5089
Mailing Address - Country:US
Mailing Address - Phone:262-488-0603
Mailing Address - Fax:
Practice Address - Street 1:6015 DURAND AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-5089
Practice Address - Country:US
Practice Address - Phone:262-488-0603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1540-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty