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General NPI Number Information
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NPI Number | 1154550754
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Entity Type | Individual
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Provider Name | ELIZABETH LYNN HANSEN PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 1035 W GLEN OAKS LN STE 110
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City | MEQUON
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State | WI
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Zip | 53092-3392
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Country | US
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Telephone | 262-240-0299
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Fax | 414-329-5637
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Provider Business Mailing Address
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Address Line | 2424 S 90TH ST SUITE 502
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City | WEST ALLIS
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State | WI
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Zip | 53227-2455
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Country | US
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Telephone | 414-329-5365
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Fax | 414-329-5637
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3087-57
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License Number State | WI
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