| Doctor Name: | KEISHA RAE MI OK HANSEN |
| NPI Number: | 1134218159 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BSW |
| License Number: | |
| Business Practice Address: | 722 15th Street Nw Bemidji, MN - 566012190 |
| Business Phone Number: | 2187513280 |
| Business Fax Number: | 2187513298 |
| Mailing Address: | 617 34th St Nw, BEMIDJI |
| State: | MN |
| Postal Code: | 566012190 |
| Phone Number: | 2187663444 |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |