Provider Demographics
NPI:1194769281
Name:HANSON, KAREN MICHELE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MICHELE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:HANSON
Other - Last Name:NEVEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2514 NORMANDY DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5471
Mailing Address - Country:US
Mailing Address - Phone:586-549-4239
Mailing Address - Fax:
Practice Address - Street 1:1155 E PARIS AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8368
Practice Address - Country:US
Practice Address - Phone:616-233-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOEO4589Medicare ID - Type Unspecified
R67499Medicare UPIN