Provider Demographics
NPI:1447626437
Name:HANSON, SONJA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:SONJA
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:ANN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:5411 S VINE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7746
Mailing Address - Country:US
Mailing Address - Phone:801-905-1619
Mailing Address - Fax:
Practice Address - Street 1:5411 S VINE ST STE 6
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7746
Practice Address - Country:US
Practice Address - Phone:801-905-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8716883-3502101YM0800X
UT8716883-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000092072Medicare PIN