Provider Demographics
NPI:1316255466
Name:HAGERUP, CINDY JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:JEAN
Last Name:HAGERUP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:JEAN
Other - Last Name:HAGERUP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2828 KRAFT AVE SE
Mailing Address - Street 2:STE 186
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2076
Mailing Address - Country:US
Mailing Address - Phone:616-819-6465
Mailing Address - Fax:616-819-2291
Practice Address - Street 1:50 ANTOINE ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1002
Practice Address - Country:US
Practice Address - Phone:616-819-6465
Practice Address - Fax:616-819-2291
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010804161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical