Provider Demographics
NPI:1134413305
Name:HANSER, MICKI S (CSW)
Entity type:Individual
Prefix:
First Name:MICKI
Middle Name:S
Last Name:HANSER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:MICKI
Other - Middle Name:S
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 N 2ND E
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3509
Mailing Address - Country:US
Mailing Address - Phone:307-857-3035
Mailing Address - Fax:
Practice Address - Street 1:515 N 2ND ST E
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3509
Practice Address - Country:US
Practice Address - Phone:307-857-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCSW-1451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical