Provider Demographics
NPI:1952948184
Name:HANSON, SUZANNE R (APSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:HANSON
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:R
Other - Last Name:UDEHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3001 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3048
Mailing Address - Country:US
Mailing Address - Phone:224-610-9100
Mailing Address - Fax:224-610-3844
Practice Address - Street 1:3001 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3048
Practice Address - Country:US
Practice Address - Phone:224-610-9100
Practice Address - Fax:224-610-3844
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130639-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker