Provider Demographics
NPI:1740343532
Name:HANSEN, SHELLEY KAY (LSW, MA, LP)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:KAY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LSW, MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 4TH ST E
Mailing Address - Street 2:SUITE #302
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2047
Mailing Address - Country:US
Mailing Address - Phone:612-532-6741
Mailing Address - Fax:
Practice Address - Street 1:105 4TH ST E
Practice Address - Street 2:SUITE #302
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2047
Practice Address - Country:US
Practice Address - Phone:612-532-6741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist