MEDICARE: MRS. PAMELA M HANSEN MSW

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	104100000X	Social Worker	1008-121	WI
2	1041C0700X	Clinical Social Worker	9532-123	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750557773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAMELA M HANSEN MSW

Provider Business Mailing Address
First Line	:	8421 N 102ND CT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2431
Country	:	US
Telephone Number	:	414-460-6995
Fax Number	:	414-355-5467

Provider Business Practice Location Address
First Line	:	6815 W CAPITOL DR STE 304
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2056
Country	:	US
Telephone Number	:	414-460-6995
Fax Number	:	414-355-5467

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	07/26/2023

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