Provider Demographics
NPI:1073639415
Name:HAGEN, LINDA (MS, ATR-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MS, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 99TH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4362
Mailing Address - Country:US
Mailing Address - Phone:414-774-6878
Mailing Address - Fax:414-774-6879
Practice Address - Street 1:601 N 99TH ST STE 307
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4362
Practice Address - Country:US
Practice Address - Phone:414-774-6878
Practice Address - Fax:414-774-6879
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72-0361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical