MEDICARE: ERIC WAYNE HANSEN LICSW LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2319	MN
2	1041C0700X	Clinical Social Worker	9021	MN

General Provider Information

NPI Number	:	1447662754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC WAYNE HANSEN LICSW LMFT

Provider Business Mailing Address
First Line	:	2808 ALDRICH AVE S UNIT 9
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2179
Country	:	US
Telephone Number	:	612-309-7469
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 FRANCE AVE S STE 230
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-1810
Country	:	US
Telephone Number	:	952-460-9007
Fax Number	:	651-383-4935

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	09/17/2024

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