Provider Demographics
NPI:1255162855
Name:HAGGE, ADDISON ELIZABETH (RD)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:ELIZABETH
Last Name:HAGGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 WALMER ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2054
Mailing Address - Country:US
Mailing Address - Phone:913-954-1606
Mailing Address - Fax:
Practice Address - Street 1:7307 WALMER ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2054
Practice Address - Country:US
Practice Address - Phone:913-954-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024011638133V00000X
KS2858133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered