Provider Demographics
NPI:1033255419
Name:CALLAHAN-HAGER, CASEY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:CASEY
Middle Name:MICHELLE
Last Name:CALLAHAN-HAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CEDAR CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:WY
Mailing Address - Zip Code:82935-4711
Mailing Address - Country:US
Mailing Address - Phone:307-875-3143
Mailing Address - Fax:307-875-3143
Practice Address - Street 1:260 CEDAR CIR
Practice Address - Street 2:
Practice Address - City:GREEN RIVER
Practice Address - State:WY
Practice Address - Zip Code:82935-4711
Practice Address - Country:US
Practice Address - Phone:307-875-3143
Practice Address - Fax:307-875-3143
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator