Healthcare Provider Details

I. General information

NPI: 1366029829
Provider Name (Legal Business Name): MARIE RENEE' HANBY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 N MAIN ST STE 230
RICE LAKE WI
54868-1774
US

IV. Provider business mailing address

138 N MAIN ST STE 200
RICE LAKE WI
54868-1774
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax: 715-254-9459
Mailing address:
  • Phone: 715-317-5466
  • Fax: 866-728-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4910-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: