Provider Demographics
NPI:1821199365
Name:HAGAN, SCOTTY THOMAS (MSW)
Entity Type:Individual
Prefix:MR
First Name:SCOTTY
Middle Name:THOMAS
Last Name:HAGAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 107
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:50138
Mailing Address - Country:US
Mailing Address - Phone:641-842-3101
Mailing Address - Fax:641-828-5377
Practice Address - Street 1:1515 WEST PLEASANT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138
Practice Address - Country:US
Practice Address - Phone:641-842-3101
Practice Address - Fax:641-828-6796
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06461104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker