Provider Demographics
NPI:1356436885
Name:HANVIK, NORA LEE (MA,CSE)
Entity type:Individual
Prefix:MS
First Name:NORA
Middle Name:LEE
Last Name:HANVIK
Suffix:
Gender:F
Credentials:MA,CSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 28TH AVE. S.
Mailing Address - Street 2:#515
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1359
Mailing Address - Country:US
Mailing Address - Phone:612-722-2653
Mailing Address - Fax:
Practice Address - Street 1:1440 49TH AVE. NE
Practice Address - Street 2:ISD #13
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:763-528-4632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2665103T00000X
MN205989103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool