Provider Demographics
NPI:1992081293
Name:HANSON, DONALD WAYNE
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WAYNE
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DONALD
Other - Middle Name:WAYNE
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STD, LCSW
Mailing Address - Street 1:2719 OAK LEIGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4209
Mailing Address - Country:US
Mailing Address - Phone:210-495-5504
Mailing Address - Fax:
Practice Address - Street 1:2719 OAK LEIGH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-4209
Practice Address - Country:US
Practice Address - Phone:210-857-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical