Provider Demographics
NPI:1043888902
Name:LIZ HANSON WILL, LLC
Entity type:Organization
Organization Name:LIZ HANSON WILL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:WILL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-260-9383
Mailing Address - Street 1:5605 WASHINGTON AVE STE 7D
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4056
Mailing Address - Country:US
Mailing Address - Phone:262-260-9383
Mailing Address - Fax:
Practice Address - Street 1:5605 WASHINGTON AVE STE 7D
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4056
Practice Address - Country:US
Practice Address - Phone:262-260-9383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40987600Medicaid
WINAOtherNA