MEDICARE: SHANTE SOOKHLALL HANSON LMFT, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2485250	MN
2	106H00000X	Marriage & Family Therapist	2192-124	WI
3	163W00000X	Registered Nurse	1119070-30	WI
4	106H00000X	Marriage & Family Therapist	2306	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073880068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTE SOOKHLALL HANSON LMFT, RN

Provider Business Mailing Address
First Line	:	5995 OREN AVE N STE 108
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-5302
Country	:	US
Telephone Number	:	612-524-9237
Fax Number	:	612-314-8317

Provider Business Practice Location Address
First Line	:	5995 OREN AVE N STE 108
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-5302
Country	:	US
Telephone Number	:	612-524-9237
Fax Number	:	612-314-8317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2011
Last Update Date	:	01/23/2026

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