Provider Demographics
NPI:1407301674
Name:HAGER, MARY OGDEN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:OGDEN
Last Name:HAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 N STAR DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718-3080
Mailing Address - Country:US
Mailing Address - Phone:314-495-0961
Mailing Address - Fax:
Practice Address - Street 1:533 N STAR DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718-3080
Practice Address - Country:US
Practice Address - Phone:314-495-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health