Provider Demographics
NPI:1063528271
Name:HAGEMOSER, STEVEN DEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DEAN
Last Name:HAGEMOSER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 AMICK AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-5740
Mailing Address - Country:US
Mailing Address - Phone:515-277-5387
Mailing Address - Fax:
Practice Address - Street 1:3600 30TH ST
Practice Address - Street 2:BUILDING 5, ROOM 110
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5753
Practice Address - Country:US
Practice Address - Phone:515-699-5679
Practice Address - Fax:515-699-5772
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00925103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical