Provider Demographics
NPI:1285868414
Name:HAGEN, GINGER L (MS, RD, LDN)
Entity Type:Individual
Prefix:MS
First Name:GINGER
Middle Name:L
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4798
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-4798
Mailing Address - Country:US
Mailing Address - Phone:630-263-9533
Mailing Address - Fax:630-206-0310
Practice Address - Street 1:26W420 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2107
Practice Address - Country:US
Practice Address - Phone:630-263-9533
Practice Address - Fax:630-206-0310
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164002840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered