1093928517 NPI number — MS. PAMELA RAE HANSON LSCSW

Table of content: MS. PAMELA RAE HANSON LSCSW (NPI 1093928517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093928517 NPI number — MS. PAMELA RAE HANSON LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSON
Provider First Name:
PAMELA
Provider Middle Name:
RAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093928517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 GLENWOOD ST
Provider Second Line Business Mailing Address:
CLOVERLEAF BUILDING #4, SUITE 315
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66202-4016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-558-9060
Provider Business Mailing Address Fax Number:
913-677-5250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 GLENWOOD ST
Provider Second Line Business Practice Location Address:
CLOVERLEAF BUILDING #4, SUITE 315
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66202-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-558-9060
Provider Business Practice Location Address Fax Number:
913-677-5250
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2153 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 29162015 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com