Provider Demographics
NPI:1407258288
Name:HALLAGAN, AMY (MSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HALLAGAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 ASPEN DR
Mailing Address - Street 2:UNIT F
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2903 ASPEN DR
Practice Address - Street 2:UNIT F
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2577
Practice Address - Country:US
Practice Address - Phone:970-593-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC 00108391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical