Provider Demographics
NPI:1336208834
Name:HAGERMAN, CHERYL L (MSSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:HAGERMAN
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2059
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:1321 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1156
Practice Address - Country:US
Practice Address - Phone:608-637-7052
Practice Address - Fax:608-637-8500
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1211-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13G84HAOtherBCBS-MN
WI39082186304OtherUNITY HEALTH INSURANCE
MNHP66982OtherHEALTHPARTNERS
WI39621300Medicaid
MN13G84HAOtherBCBS-MN
WI39621300Medicaid