=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215501861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LYNN HANSEN ASW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2021
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 WILLOW PASS RD # 200
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520-5823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-521-5153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1381
-----------------------------------------------------
City | BENICIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94510-4381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-346-1986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW117950
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------