Provider Demographics
NPI:1710309786
Name:HAGEN, MELISSA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HAGEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27145 S FIRST POINT LANDING RD
Mailing Address - Street 2:
Mailing Address - City:GOETZVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49736-9371
Mailing Address - Country:US
Mailing Address - Phone:906-440-7105
Mailing Address - Fax:
Practice Address - Street 1:27145 S FIRST POINT LANDING RD
Practice Address - Street 2:
Practice Address - City:GOETZVILLE
Practice Address - State:MI
Practice Address - Zip Code:49736-9371
Practice Address - Country:US
Practice Address - Phone:906-440-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010878371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical