Provider Demographics
NPI:1932195377
Name:HANSEN, SHARON KAY (MA CNS LMFT)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA CNS LMFT
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:RIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 1/2 N CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-1632
Mailing Address - Country:US
Mailing Address - Phone:605-745-4770
Mailing Address - Fax:605-745-4770
Practice Address - Street 1:112 1/2 N CHICAGO ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-1632
Practice Address - Country:US
Practice Address - Phone:605-745-4770
Practice Address - Fax:605-745-4770
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1140106H00000X
SDCNS4009364SP0808X
SDRN013249364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575090Medicaid
SD5914Medicare ID - Type Unspecified
SD6575090Medicaid