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General NPI Number Information
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NPI Number | 1992254759
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Entity Type | Individual
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Provider Name | HEIDI HANSON LADC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 308 12TH AVE S
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City | BUFFALO
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State | MN
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Zip | 55313-2321
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Country | US
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Telephone | 763-682-4400
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Fax | 763-682-1353
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Provider Business Mailing Address
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Address Line | 3400 1ST ST N STE 101
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1924
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Country | US
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Telephone | 320-230-0567
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Fax | 320-253-1684
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304337
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License Number State | MN
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