Provider Demographics
NPI:1023394913
Name:HAGEN, JANET W (PHD)
Entity type:Individual
Prefix:DR
First Name:JANET
Middle Name:W
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CANDLELIGHT CT
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7301
Mailing Address - Country:US
Mailing Address - Phone:920-420-3825
Mailing Address - Fax:
Practice Address - Street 1:1310 CANDLELIGHT CT
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7301
Practice Address - Country:US
Practice Address - Phone:920-420-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional