Healthcare Provider Details

I. General information

NPI: 1790668192
Provider Name (Legal Business Name): ROCHELLE LOIS HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 S POKEGAMA AVE LOWR LEVEL
GRAND RAPIDS MN
55744-3934
US

IV. Provider business mailing address

PO BOX 122
LEEDS ND
58346-0122
US

V. Phone/Fax

Practice location:
  • Phone: 218-999-9432
  • Fax:
Mailing address:
  • Phone: 701-609-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: