Provider Demographics
NPI:1447662754
Name:HANSEN, ERIC WAYNE (LICSW LMFT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WAYNE
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LICSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 ALDRICH AVE S UNIT 9
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2179
Mailing Address - Country:US
Mailing Address - Phone:612-309-7469
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 230
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1810
Practice Address - Country:US
Practice Address - Phone:952-460-9007
Practice Address - Fax:651-383-4935
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2319106H00000X
MN90211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist