Provider Demographics
NPI:1164101473
Name:HAGENESS, OLIVIA C (MS LPC-IT)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:C
Last Name:HAGENESS
Suffix:
Gender:F
Credentials:MS LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19968 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6476
Mailing Address - Country:US
Mailing Address - Phone:715-533-2516
Mailing Address - Fax:
Practice Address - Street 1:1791 COUNTY HIGHWAY OO
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-5347
Practice Address - Country:US
Practice Address - Phone:715-797-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7210-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health