Provider Demographics
NPI:1477399376
Name:HAGLUND, LISA (LMSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAGLUND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 COUNTY ROAD 223
Mailing Address - Street 2:
Mailing Address - City:KINGDOM CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65262-1905
Mailing Address - Country:US
Mailing Address - Phone:573-721-9930
Mailing Address - Fax:573-731-3390
Practice Address - Street 1:2606 N BLUFF ST STE 102A
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MO
Practice Address - Zip Code:65251-7257
Practice Address - Country:US
Practice Address - Phone:573-751-9930
Practice Address - Fax:573-731-3390
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240222001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical