Provider Demographics
NPI:1093059719
Name:HAGG, LORI L (TLMFT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:HAGG
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 5TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2128
Mailing Address - Country:US
Mailing Address - Phone:319-398-3943
Mailing Address - Fax:319-398-3577
Practice Address - Street 1:819 5TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2128
Practice Address - Country:US
Practice Address - Phone:319-398-3943
Practice Address - Fax:319-398-3577
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist