MEDICARE: MRS. BARBARA JEAN HANSON L.C.S.W.

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	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0009232018	OTHER	IL	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1518062744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA JEAN HANSON L.C.S.W.

Provider Business Mailing Address
First Line	:	21644 N 1365 EAST RD
Second Line	:	FOREST HILLS ESTATES
City	:	DANVILLE
State	:	IL
Zip	:	61834-5596
Country	:	US
Telephone Number	:	217-260-0118
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 OAK ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61832-3825
Country	:	US
Telephone Number	:	217-446-5860
Fax Number	:	217-446-6058

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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