Provider Demographics
NPI:1427464221
Name:HANSON, SAMANTHA J I (MS, LPC, ATR)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:J
Last Name:HANSON
Suffix:I
Gender:F
Credentials:MS, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4863
Mailing Address - Country:US
Mailing Address - Phone:920-659-0078
Mailing Address - Fax:920-843-9395
Practice Address - Street 1:516 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4863
Practice Address - Country:US
Practice Address - Phone:920-659-0078
Practice Address - Fax:920-843-9395
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5895101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100040516Medicaid