Individual
HEIDI ANN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
505 S 12TH AVE W STE 1, VIRGINIA, MN 55792-2001
(218) 749-2877
(218) 749-6033
Mailing address
505 S 12TH AVE W STE 1, VIRGINIA, MN 55792-2001
(218) 749-2877
(218) 749-6033
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619984028
—
MN
Enumeration date
12/11/2017
Last updated
12/11/2017
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