Provider Demographics
NPI:1316471253
Name:HAGLUND, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HAGLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:PROF
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:HAGLUND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RTR, ATC
Mailing Address - Street 1:7633 BENNETT CT
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55077-3221
Mailing Address - Country:US
Mailing Address - Phone:612-749-3809
Mailing Address - Fax:
Practice Address - Street 1:7633 BENNETT CT
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-3221
Practice Address - Country:US
Practice Address - Phone:612-749-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN354637247100000X
MN1415405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No405300000XOther Service ProvidersPrevention Professional