Healthcare Provider Details

I. General information

NPI: 1417621889
Provider Name (Legal Business Name): JENNIFER LYNN HANSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 EUSTIS PKWY
WATERVILLE ME
04901-5173
US

IV. Provider business mailing address

746 E PITTSTON RD
PITTSTON ME
04345-5912
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-2136
  • Fax:
Mailing address:
  • Phone: 215-589-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013271
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC6993
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: