Healthcare Provider Details

I. General information

NPI: 1336331248
Provider Name (Legal Business Name): CASEY ANN HANSON PH.D., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W6240 COMMUNICATION CT STE 2
APPLETON WI
54914-8549
US

IV. Provider business mailing address

W6240 COMMUNICATION CT STE 2
APPLETON WI
54914-8549
US

V. Phone/Fax

Practice location:
  • Phone: 203-640-7479
  • Fax: 920-364-0747
Mailing address:
  • Phone: 920-364-0747
  • Fax: 920-364-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3646-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2798
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2798-057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: