Individual
MS. MARY ROBERTA HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
111 N JEFFERSON ST, GREEN BAY, WI 54301-5005
(920) 448-6328
(920) 448-6065
Mailing address
2540 GARDEN PARK TER, GREEN BAY, WI 54311-6744
(920) 448-6328
(920) 448-6065
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1684-120
WI
Other
Enumeration date
09/30/2015
Last updated
09/30/2015
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