Provider Demographics
NPI:1922637180
Name:HAGENOW, BRIANNA MARIE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:HAGENOW
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:LUTHERAN SOCIAL SERVICES OF WI
Mailing Address - Street 2:830 EDGEWOOD DRIVE
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LUTHERAN SOCIAL SERVICES OF WI
Practice Address - Street 2:830 EDGEWOOD DRIVE
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311
Practice Address - Country:US
Practice Address - Phone:920-471-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator