Healthcare Provider Details

I. General information

NPI: 1285365304
Provider Name (Legal Business Name): CALVIN HANSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date: 09/09/2022
Reactivation Date: 11/16/2022

III. Provider practice location address

1845 N FARWELL AVE STE 218
MILWAUKEE WI
53202-1715
US

IV. Provider business mailing address

1785 N WATER ST APT 1531
MILWAUKEE WI
53202-1273
US

V. Phone/Fax

Practice location:
  • Phone: 262-737-4120
  • Fax:
Mailing address:
  • Phone: 262-737-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11851-123
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: