MEDICARE: DR. CASEY ANN HANSON PH.D., LPC

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	101YM0800X	Mental Health Counselor	3646-125	WI
2	103TC0700X	Clinical Psychologist	2798	WI
3	103TC0700X	Clinical Psychologist	2798-057	WI

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	:	1336331248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY ANN HANSON PH.D., LPC

Provider Business Mailing Address
First Line	:	W6240 COMMUNICATION CT STE 2
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-8549
Country	:	US
Telephone Number	:	920-364-0747
Fax Number	:	920-364-0747

Provider Business Practice Location Address
First Line	:	W6240 COMMUNICATION CT STE 2
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54914-8549
Country	:	US
Telephone Number	:	203-640-7479
Fax Number	:	920-364-0747

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	11/06/2023

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