Provider Demographics
NPI:1417077298
Name:HAGEMAN, EVA J (EDS, NCSP)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:J
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19315 N 75TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6029
Mailing Address - Country:US
Mailing Address - Phone:623-594-0191
Mailing Address - Fax:623-445-4180
Practice Address - Street 1:20012 N 35TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-2204
Practice Address - Country:US
Practice Address - Phone:623-445-4120
Practice Address - Fax:623-445-4180
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist