Provider Demographics
NPI:1336331248
Name:HANSON, CASEY ANN (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W6240 COMMUNICATION CT STE 2
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-8549
Mailing Address - Country:US
Mailing Address - Phone:920-364-0747
Mailing Address - Fax:920-364-0747
Practice Address - Street 1:W6240 COMMUNICATION CT STE 2
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-8549
Practice Address - Country:US
Practice Address - Phone:203-640-7479
Practice Address - Fax:920-364-0747
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3646-125101YM0800X
WI2798103TC0700X
WI2798-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41000400Medicaid