Provider Demographics
NPI:1811960719
Name:HANSEN, JOHN (LP)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 AUSTIN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4402
Mailing Address - Country:US
Mailing Address - Phone:507-446-8123
Mailing Address - Fax:
Practice Address - Street 1:1880 AUSTIN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4402
Practice Address - Country:US
Practice Address - Phone:507-446-8123
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical