Basic Information
| Provider Information | |||||||||
| NPI: | 1558542027 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON-LIU | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 E 3RD ST | ||||||||
| Address2: | 201 | ||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559873478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074527292 | ||||||||
| FaxNumber: | 5074579887 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 COUNTY ROAD R | ||||||||
| Address2: | |||||||||
| City: | BLACK RIVER FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546155129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152849477 | ||||||||
| FaxNumber: | 7152845547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 11/27/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.