Provider Demographics
NPI:1063474237
Name:HAGLUND, SUSAN V (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:V
Last Name:HAGLUND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 W 5TH AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-1912
Mailing Address - Country:US
Mailing Address - Phone:614-481-1937
Mailing Address - Fax:
Practice Address - Street 1:1989 W 5TH AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-1912
Practice Address - Country:US
Practice Address - Phone:614-481-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2230103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HACP19631Medicare ID - Type Unspecified