Provider Demographics
NPI:1871126268
Name:HANSON, CASEY L (CAPSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:L
Last Name:HANSON
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 E CHERYL PKWY UNIT 329
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-7716
Mailing Address - Country:US
Mailing Address - Phone:715-418-1139
Mailing Address - Fax:
Practice Address - Street 1:5148 E CHERYL PKWY UNIT 329
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-7716
Practice Address - Country:US
Practice Address - Phone:715-418-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131229-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker