Provider Demographics
NPI:1770926446
Name:HANSEN, MARILSA (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARILSA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 N AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:MC FARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8612
Mailing Address - Country:US
Mailing Address - Phone:608-838-7931
Mailing Address - Fax:
Practice Address - Street 1:6320 MONONA DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3952
Practice Address - Country:US
Practice Address - Phone:608-467-9074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4572-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor