Provider Demographics
NPI:1104930940
Name:HANSEN, CHRISTINE M (MS LCSW SAC LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MS LCSW SAC LPC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:M
Other - Last Name:HORNUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LPC, SAC
Mailing Address - Street 1:1095 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1115
Mailing Address - Country:US
Mailing Address - Phone:920-720-2300
Mailing Address - Fax:920-720-3719
Practice Address - Street 1:333 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-1954
Practice Address - Country:US
Practice Address - Phone:920-720-2300
Practice Address - Fax:920-720-3719
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12499101YA0400X
WI915101YP2500X
WI1805-123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39640300Medicaid