Provider Demographics
NPI:1770028003
Name:HANSEN, WENDY R (LADC, PLMHP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:R
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LADC, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6346
Mailing Address - Country:US
Mailing Address - Phone:308-383-5605
Mailing Address - Fax:
Practice Address - Street 1:218 S RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6346
Practice Address - Country:US
Practice Address - Phone:308-383-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1231101YA0400X
NE13089101YM0800X
NE1347101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health