Provider Demographics
NPI:1477310936
Name:HANSEN, KARI L (LADC)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TOWN SQUARE LN # 55021
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6088
Mailing Address - Country:US
Mailing Address - Phone:507-323-8100
Mailing Address - Fax:
Practice Address - Street 1:1415 TOWN SQUARE LN
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6088
Practice Address - Country:US
Practice Address - Phone:507-323-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306916101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)