Provider Demographics
NPI:1588212591
Name:HAGEMEYER, DEBRA LYNN (HIS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:HAGEMEYER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 3RD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3432
Mailing Address - Country:US
Mailing Address - Phone:812-630-2897
Mailing Address - Fax:
Practice Address - Street 1:332 3RD AVE STE 3
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3432
Practice Address - Country:US
Practice Address - Phone:812-482-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001294A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty