Healthcare Provider Details

I. General information

NPI: 1508876897
Provider Name (Legal Business Name): JENNIFER MARIE HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA HANSON

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S CENTRAL AVE
MARSHFIELD WI
54449
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-2729
  • Fax: 715-387-4526
Mailing address:
  • Phone: 414-266-7451
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number126586-121
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7581-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: