BLAKE G HANSEN

JACKSON, WY
NPI1518281286
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker, Clinical
(Licence: WY  LCSW- 365)
Enumeration Date2010-03-24
Last Update Date2011-07-16
Business Address
-- BLAKE G HANSEN LCSW
640 E BROADWAY
JACKSON, WY 83001
Phone number: 307-733-2046
Mailing Address
-- BLAKE G HANSEN LCSW
PO BOX 1868
JACKSON, WY 83001-1868
Phone number: 307-733-2046
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