Provider Demographics
NPI:1326352436
Name:HAGMANN, ALYSSA DIANE (MARR & FAM THERAPIST)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DIANE
Last Name:HAGMANN
Suffix:
Gender:F
Credentials:MARR & FAM THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 N BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-1550
Mailing Address - Country:US
Mailing Address - Phone:253-254-6681
Mailing Address - Fax:
Practice Address - Street 1:2205 N 30TH ST STE A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3320
Practice Address - Country:US
Practice Address - Phone:253-254-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60102496171M00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator