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NPI Code Detail

MEDICARE: DAVID EDWARD HANSEN LCSW

MEDICARE: DAVID EDWARD HANSEN LCSW
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
11041C0700XClinical Social Worker34003271AIN

Other Identifiers

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

General Provider Information

NPI Number : 1417932062
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EDWARD HANSEN LCSW
Provider Business Mailing Address
First Line : 8180 CLEARVISTA PARKWAY
Second Line : SUITE 230 ATTN SHERRY MUELLER
City : INDIANAPOLIS
State : IN
Zip : 46256-4649
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7 EAST HENDRICKS STREET
Second Line :
City : SHELBYVILLE
State : IN
Zip : 46176-2124
Country : US
Telephone Number : 317-392-2564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 08/03/2010

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