Provider Demographics
NPI:1275819815
Name:HAGLUND, MONICA (CADC 1)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HAGLUND
Suffix:
Gender:F
Credentials:CADC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45741 GRACE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTONE
Mailing Address - State:MN
Mailing Address - Zip Code:55072-3203
Mailing Address - Country:US
Mailing Address - Phone:320-384-0149
Mailing Address - Fax:
Practice Address - Street 1:43500 MIGIZI DR
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-2241
Practice Address - Country:US
Practice Address - Phone:320-532-4163
Practice Address - Fax:320-532-7542
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN08-0117-MN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)