Provider Demographics
NPI:1043448970
Name:HAGEN, ASHLEY LYNNE (MS, ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LYNNE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:LYNNE
Other - Last Name:FANGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47050 COUNTY ROAD X
Mailing Address - Street 2:
Mailing Address - City:SOLDIERS GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:54655-8551
Mailing Address - Country:US
Mailing Address - Phone:608-735-4311
Mailing Address - Fax:608-735-4317
Practice Address - Street 1:47050 COUNTY ROAD X
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-8551
Practice Address - Country:US
Practice Address - Phone:608-735-4311
Practice Address - Fax:608-735-4317
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer