MEDICARE: MS. JENNIFER ROSE HANSON 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
1	104100000X	Social Worker	11382	WI
2	1041C0700X	Clinical Social Worker	127646-121	WI

General Provider Information

NPI Number	:	1437303005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ROSE HANSON LCSW

Provider Business Mailing Address
First Line	:	1053 WILLIAMSON ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3525
Country	:	US
Telephone Number	:	608-698-5634
Fax Number	:

Provider Business Practice Location Address
First Line	:	1053 WILLIAMSON ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53703-3525
Country	:	US
Telephone Number	:	608-698-5634
Fax Number	:

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

Provider Enumeration Date	:	11/10/2008
Last Update Date	:	10/17/2023

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