Healthcare Provider Details

I. General information

NPI: 1013838309
Provider Name (Legal Business Name): ELIZABETH J HANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SHERMAN AVE E
FORT ATKINSON WI
53538-1960
US

IV. Provider business mailing address

611 SHERMAN AVE E
FORT ATKINSON WI
53538-1960
US

V. Phone/Fax

Practice location:
  • Phone: 608-647-4705
  • Fax: 608-268-9780
Mailing address:
  • Phone: 608-647-4705
  • Fax: 608-268-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131830-121
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: