Provider Demographics
NPI:1750557773
Name:HANSEN, PAMELA M (MSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MICHELLE
Other - Last Name:TOWNSEND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8421 N 102ND CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2431
Mailing Address - Country:US
Mailing Address - Phone:414-460-6995
Mailing Address - Fax:414-355-5467
Practice Address - Street 1:6815 W CAPITOL DR STE 304
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2056
Practice Address - Country:US
Practice Address - Phone:414-460-6995
Practice Address - Fax:414-355-5467
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1008-121104100000X
WI9532-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43575900Medicaid