Provider Demographics
NPI:1518972272
Name:HAGEN, KIMBERLY M (LISW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:M
Last Name:HAGEN
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 1:78 LANDON DR NW
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-2618
Mailing Address - Country:US
Mailing Address - Phone:641-485-9865
Mailing Address - Fax:
Practice Address - Street 1:78 LANDON DR NW
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-2618
Practice Address - Country:US
Practice Address - Phone:641-485-9865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA167031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA321119OtherVALUE OPTIONS
IA0058230Medicaid
IA05823OtherBCBS
IA250491OtherMIDLANDS CHOICE
IA124961OtherHEALTH ALLIANCE
IA05823OtherBCBS