Healthcare Provider Details

I. General information

NPI: 1578455028
Provider Name (Legal Business Name): CODY J HANSEN LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N 71 BUSINESS HWY
ANDERSON MO
64831-9753
US

IV. Provider business mailing address

6 FAYE LN
BELLA VISTA AR
72714-4028
US

V. Phone/Fax

Practice location:
  • Phone: 417-355-9401
  • Fax: 417-845-8314
Mailing address:
  • Phone: 479-321-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2025028929
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: