Provider Demographics
NPI:1467279034
Name:HAGER, MADELYN KAY (BCBA)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:KAY
Last Name:HAGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:16880 MIDDLEBELT RD STE 1
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3374
Practice Address - Country:US
Practice Address - Phone:734-203-7675
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-24-75280103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst