Provider Demographics
NPI:1922289164
Name:HAGERMAN-HARRIS, KELLEY ALICIA (MA)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:ALICIA
Last Name:HAGERMAN-HARRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:ALICIA
Other - Last Name:HAGERMAN-HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0329
Mailing Address - Country:US
Mailing Address - Phone:509-524-2920
Mailing Address - Fax:509-524-2993
Practice Address - Street 1:1520 KELLEY PL
Practice Address - Street 2:FLOOR 2
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-8654
Practice Address - Country:US
Practice Address - Phone:509-524-2920
Practice Address - Fax:541-966-7799
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health