Healthcare Provider Details

I. General information

NPI: 1194293092
Provider Name (Legal Business Name): NATALIE JOSEPHINE HANSON LPC, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE JOSEPHINE BUELOW, MINTURN NONE

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6789 N GREEN BAY AVE # M2-T2
GLENDALE WI
53209-3472
US

IV. Provider business mailing address

8415 N PELICAN LN
RIVER HILLS WI
53217-2059
US

V. Phone/Fax

Practice location:
  • Phone: 414-395-0118
  • Fax:
Mailing address:
  • Phone: 262-977-0119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4119-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18673-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: