Provider Demographics
NPI:1285098202
Name:HAGEN, DEBORAH (LADC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ABBEY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2333
Mailing Address - Country:US
Mailing Address - Phone:952-666-5910
Mailing Address - Fax:952-456-8783
Practice Address - Street 1:2601 ABBEY HILL DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2333
Practice Address - Country:US
Practice Address - Phone:952-666-5910
Practice Address - Fax:952-456-8783
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302489101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)