Healthcare Provider Details

I. General information

NPI: 1477310936
Provider Name (Legal Business Name): KARI L HANSEN LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BROADWAY AVE N STE 104
ROCHESTER MN
55906-4144
US

IV. Provider business mailing address

1700 BROADWAY AVE N STE 104
ROCHESTER MN
55906-4144
US

V. Phone/Fax

Practice location:
  • Phone: 507-208-4006
  • Fax: 507-206-4005
Mailing address:
  • Phone: 507-208-4006
  • Fax: 507-206-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306916
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: