Healthcare Provider Details

I. General information

NPI: 1104930940
Provider Name (Legal Business Name): CHRISTINE M HANSEN MS LCSW SAC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE M. HORNUNG LCSW, LPC, SAC

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N GREEN BAY RD
NEENAH WI
54956-1954
US

IV. Provider business mailing address

1095 MIDWAY RD
MENASHA WI
54952-1115
US

V. Phone/Fax

Practice location:
  • Phone: 920-720-2300
  • Fax: 920-720-3719
Mailing address:
  • Phone: 920-720-2300
  • Fax: 920-720-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12499
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number915
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1805-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: