Provider Demographics
NPI:1013529114
Name:KELI HAGEN LISW, PLLC
Entity Type:Organization
Organization Name:KELI HAGEN LISW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KELI
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:319-213-2922
Mailing Address - Street 1:4403 1ST AVE SE STE 412
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3221
Mailing Address - Country:US
Mailing Address - Phone:319-213-2922
Mailing Address - Fax:
Practice Address - Street 1:4403 1ST AVE SE STE 412
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3221
Practice Address - Country:US
Practice Address - Phone:319-213-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty