Provider Demographics
NPI:1720839434
Name:HAGEDON, AARON SAMUEL (LCSW)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:SAMUEL
Last Name:HAGEDON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BUSINESS PARK CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-5501
Mailing Address - Country:US
Mailing Address - Phone:608-698-2744
Mailing Address - Fax:
Practice Address - Street 1:100 BUSINESS PARK CIR STE 202
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-5501
Practice Address - Country:US
Practice Address - Phone:608-698-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90041231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical