Provider Demographics
NPI:1467718023
Name:HAGLAGE, KATHLEEN LOWES (LISW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LOWES
Last Name:HAGLAGE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 ALLIANCE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4754
Mailing Address - Country:US
Mailing Address - Phone:513-891-0650
Mailing Address - Fax:513-891-2838
Practice Address - Street 1:10200 ALLIANCE RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-4753
Practice Address - Country:US
Practice Address - Phone:513-891-0650
Practice Address - Fax:513-891-2838
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12000011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311705723OtherTAX ID