Basic Information
| Provider Information | |||||||||
| NPI: | 1669807715 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1309 8170 33RD AVE S | ||||||||
| Address2: | MAIL STOP 21110Q | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525412500 | ||||||||
| FaxNumber: | 9525412539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 GAMBLE DR STE 100 | ||||||||
| Address2: | MAIL STOP 31200A | ||||||||
| City: | SAINT LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554161582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525412500 | ||||||||
| FaxNumber: | 9525412539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2013 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2036 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.