MEDICARE: MR. VERNON LEE HANSON LICSW

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	00368	MN

General Provider Information

NPI Number	:	1609041755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VERNON LEE HANSON LICSW

Provider Business Mailing Address
First Line	:	PO BOX 1148
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-1148
Country	:	US
Telephone Number	:	218-749-9789
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 1ST ST S
Second Line	:
City	:	VIRGINIA
State	:	MN
Zip	:	55792-2696
Country	:	US
Telephone Number	:	218-749-9789
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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