Provider Demographics
NPI:1609266303
Name:HAGER, BREANNA M (LCSW)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:M
Last Name:HAGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1400
Mailing Address - Country:US
Mailing Address - Phone:217-824-4905
Mailing Address - Fax:217-824-3570
Practice Address - Street 1:730 N PAWNEE ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1400
Practice Address - Country:US
Practice Address - Phone:217-824-4905
Practice Address - Fax:217-824-3570
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0173151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical