Provider Demographics
NPI:1144784034
Name:HAGAN, ANNA MARIE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:HAGAN
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 1:103 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3519
Mailing Address - Country:US
Mailing Address - Phone:507-345-7012
Mailing Address - Fax:
Practice Address - Street 1:103 N BROAD ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3519
Practice Address - Country:US
Practice Address - Phone:507-345-7012
Practice Address - Fax:507-388-6937
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst