Provider Demographics
NPI:1952436008
Name:JAGOW, HANNA MARY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:MARY
Last Name:JAGOW
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 NE BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1233
Mailing Address - Country:US
Mailing Address - Phone:503-281-3318
Mailing Address - Fax:503-281-0937
Practice Address - Street 1:1205 NE BROADWAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1233
Practice Address - Country:US
Practice Address - Phone:503-281-3318
Practice Address - Fax:503-281-0937
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC2185OtherPROFESSIONAL COUNSELOR LICENSE