Provider Demographics
NPI:1154550754
Name:HANSEN, ELIZABETH LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PSYD
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Mailing Address - Street 1:2424 S 90TH ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2455
Mailing Address - Country:US
Mailing Address - Phone:414-329-5365
Mailing Address - Fax:414-329-5637
Practice Address - Street 1:1035 W GLEN OAKS LN STE 110
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3392
Practice Address - Country:US
Practice Address - Phone:262-240-0299
Practice Address - Fax:414-329-5637
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3087-57103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical