Provider Demographics
NPI:1851729727
Name:HAGEMAN, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 W A ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-4695
Mailing Address - Country:US
Mailing Address - Phone:084-178-5553
Mailing Address - Fax:308-221-6869
Practice Address - Street 1:1214 W A ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4695
Practice Address - Country:US
Practice Address - Phone:308-417-8555
Practice Address - Fax:308-221-6869
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10101101YM0800X
NE3538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health