Doctor Name: | MELONY ANN HANSEN |
NPI Number: | 1356526610 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CSW, SAC-IT |
License Number: | 15771-130 |
Business Practice Address: | 1321 N Main St Viroqua, WI - 546651156 |
Business Phone Number: | 6086377052 |
Business Fax Number: | 6086378500 |
Mailing Address: | 66 E 3rd St, 201 WINONA |
State: | MN |
Postal Code: | 559873478 |
Phone Number: | 5074527292 |
Fax Number: | 5074579887 |
NPI Enumeration Date: | 01/07/2008 |
NPI Last Update Date: | 06/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 15771-130 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |