Provider Demographics
NPI:1396339552
Name:HANSEN, WENDY ANN (CSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-6013
Mailing Address - Country:US
Mailing Address - Phone:801-557-9720
Mailing Address - Fax:
Practice Address - Street 1:1026 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-6013
Practice Address - Country:US
Practice Address - Phone:801-557-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10566923-3502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health