Healthcare Provider Details

I. General information

NPI: 1780527119
Provider Name (Legal Business Name): HAILEY HENSEL MSW STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 KENWOOD AVE
DULUTH MN
55811-4199
US

IV. Provider business mailing address

1829 E 5TH ST APT A
DULUTH MN
55812-1343
US

V. Phone/Fax

Practice location:
  • Phone: 218-723-6046
  • Fax:
Mailing address:
  • Phone: 218-839-4973
  • Fax:

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:
Title or Position:
Credential:
Phone: