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General NPI Number Information
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NPI Number | 1316759780
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Entity Type | Individual
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Provider Name | LINDSAY NICOLE HANENBURG LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 12555 UNIVERSITY AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55434-2108
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Country | US
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Telephone | 763-506-6610
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Fax |
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Provider Business Mailing Address
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Address Line | 13631 186TH AVE NW
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City | ELK RIVER
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State | MN
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Zip | 55330-1603
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Country | US
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Telephone |
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28200
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 1006855
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License Number State | MN
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