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General NPI Number Information
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NPI Number | 1871867549
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Entity Type | Organization
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Legal Business Name | STACIA HANSON MA LP LLC
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 7101 YORK AVE S SUITE 317
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-921-3266
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Fax | 651-224-3765
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Provider Business Mailing Address
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Address Line | 7101 YORK AVE S SUITE 317
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-921-3266
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Fax | 651-224-3765
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Authorized Official
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Title or Position | CEO, OWNER
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Name | STACIA HANSON
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Credential | MA LP
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Telephone | 952-921-3266
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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