Healthcare Provider Details

I. General information

NPI: 1194698704
Provider Name (Legal Business Name): LAURA HANSEN MSW, LICSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 30TH ST NW
BEMIDJI MN
56601-4140
US

IV. Provider business mailing address

1526 30TH ST NW
BEMIDJI MN
56601-4140
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-0887
  • Fax: 218-759-4807
Mailing address:
  • Phone: 218-751-0887
  • Fax: 218-759-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LAURA HANSEN
Title or Position: OWNER
Credential: MSW, LICSW
Phone: 218-556-3209