Provider Demographics
NPI:1992758767
Name:HANSON, NANCY C (LCSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8160 HIGHLAND DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6492
Mailing Address - Country:US
Mailing Address - Phone:801-942-4444
Mailing Address - Fax:801-733-4007
Practice Address - Street 1:8160 HIGHLAND DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6492
Practice Address - Country:US
Practice Address - Phone:801-942-4444
Practice Address - Fax:801-733-4007
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84-128678-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR61172Medicare UPIN