Individual
MR. JOHN MARTIN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
2550 UNIVERSITY AVE W, SUITE 229N, SAINT PAUL, MN 55114-1052
(651) 645-3115
(651) 645-2752
Mailing address
1600 UNIVERSITY AVE W, SUITE 400, SAINT PAUL, MN 55104-3898
(651) 434-3325
(651) 645-2752
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3679
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
795217100
—
MN
Enumeration date
09/20/2006
Last updated
08/26/2009
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