Provider Demographics
NPI:1497418347
Name:BAGAN, TONI MICHELLE (BSW)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:MICHELLE
Last Name:BAGAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WILLIAMS ST STE A
Mailing Address - Street 2:
Mailing Address - City:ANAMOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52205-1839
Mailing Address - Country:US
Mailing Address - Phone:319-462-4327
Mailing Address - Fax:
Practice Address - Street 1:110 S WILLIAMS ST STE A
Practice Address - Street 2:
Practice Address - City:ANAMOSA
Practice Address - State:IA
Practice Address - Zip Code:52205-1839
Practice Address - Country:US
Practice Address - Phone:319-462-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker