Provider Demographics
NPI:1932537545
Name:HAGEN, HOLLY MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MARIE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1451 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-5917
Mailing Address - Country:US
Mailing Address - Phone:847-469-7537
Mailing Address - Fax:847-469-7540
Practice Address - Street 1:1451 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-469-7537
Practice Address - Fax:847-469-7540
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042676A103G00000X
IL071008672103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist