Provider Demographics
NPI:1265101976
Name:HAGER, ERIKA REGAN
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:REGAN
Last Name:HAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ERIKA
Other - Middle Name:REGAN
Other - Last Name:DEZELLEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20199 SW MIDLINE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-8019
Mailing Address - Country:US
Mailing Address - Phone:509-945-0396
Mailing Address - Fax:
Practice Address - Street 1:12655 SW CENTER ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1600
Practice Address - Country:US
Practice Address - Phone:503-828-3402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health