Provider Demographics
NPI:1821847302
Name:HAGGERTY, ADAM LEE (LPC-IT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:LEE
Last Name:HAGGERTY
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 S 74TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1815
Mailing Address - Country:US
Mailing Address - Phone:414-659-8195
Mailing Address - Fax:
Practice Address - Street 1:7954 HARWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2512
Practice Address - Country:US
Practice Address - Phone:414-604-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4966-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty