Healthcare Provider Details

I. General information

NPI: 1174738074
Provider Name (Legal Business Name): JENNIFER ELAINE HANSEN PHD LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N EISENHOWER AVE
MASON CITY IA
50401-7340
US

IV. Provider business mailing address

1263 N 15TH ST
LARAMIE WY
82072-2343
US

V. Phone/Fax

Practice location:
  • Phone: 641-423-5479
  • Fax:
Mailing address:
  • Phone: 307-745-9815
  • Fax: 307-745-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number885
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001692
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: