Healthcare Provider Details

I. General information

NPI: 1720397201
Provider Name (Legal Business Name): RONNIE LOUISE HANSEN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONNIE LOUISE MORELLA

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MAIN STREET
PHILOMATH OR
97370
US

IV. Provider business mailing address

710 SW 57TH ST
CORVALLIS OR
97333-4480
US

V. Phone/Fax

Practice location:
  • Phone: 541-609-0462
  • Fax:
Mailing address:
  • Phone: 541-609-0462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7842
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: