Provider Demographics
NPI:1043041783
Name:HANSON, ELISABETH (LMSW)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:130 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2206
Mailing Address - Country:US
Mailing Address - Phone:316-283-6743
Mailing Address - Fax:
Practice Address - Street 1:3820 N TOBEN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2903
Practice Address - Country:US
Practice Address - Phone:316-634-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13627104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker