Healthcare Provider Details

I. General information

NPI: 1861087645
Provider Name (Legal Business Name): CANDACE HANSEN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N COLLEGE PARK ST STE 700
DERBY KS
67037-3666
US

IV. Provider business mailing address

1121 N COLLEGE PARK ST STE 700
DERBY KS
67037-3666
US

V. Phone/Fax

Practice location:
  • Phone: 316-847-6797
  • Fax: 316-425-7779
Mailing address:
  • Phone: 316-847-9117
  • Fax: 316-425-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07187
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10340
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: