Provider Demographics
NPI:1265642284
Name:HAGEDORN, BARBARA C (LMHC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:C
Last Name:HAGEDORN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2147
Mailing Address - Country:US
Mailing Address - Phone:509-624-5115
Mailing Address - Fax:
Practice Address - Street 1:104 S FREYA ST
Practice Address - Street 2:LILAC BLDG, SUITE # 118
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4862
Practice Address - Country:US
Practice Address - Phone:509-535-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health