Individual
BLAINE EDWARD HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
5500 94TH AVE N, BROOKLYN PARK, MN 55443-1992
(763) 762-8862
(763) 315-6685
Mailing address
9400 ZANE AVE N, BROOKLYN PARK, MN 55443-1814
(763) 762-8862
(763) 315-6685
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
26434
MN
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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