Provider Demographics
NPI:1811566094
Name:HAGESFELD-BOHINC, JAN (LISW-S)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:HAGESFELD-BOHINC
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7659 CAIRN LN
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9738
Mailing Address - Country:US
Mailing Address - Phone:440-840-4542
Mailing Address - Fax:
Practice Address - Street 1:7659 CAIRN LN
Practice Address - Street 2:
Practice Address - City:GATES MILLS
Practice Address - State:OH
Practice Address - Zip Code:44040-9738
Practice Address - Country:US
Practice Address - Phone:440-840-4542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0002396101YP2500X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health