Provider Demographics
NPI:1659432961
Name:HAGEN, CAROL SUE (MSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SUE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PAINE ST D
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2411
Mailing Address - Country:US
Mailing Address - Phone:563-382-9572
Mailing Address - Fax:563-382-1777
Practice Address - Street 1:1111 PAINE ST D
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2411
Practice Address - Country:US
Practice Address - Phone:563-382-1900
Practice Address - Fax:563-382-1777
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00801OtherLISW