MEDICARE: AMANDA ROCHELLE HAGEDORN PLMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	12943	NE

General Provider Information

NPI Number	:	1285274837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ROCHELLE HAGEDORN PLMHP

Provider Business Mailing Address
First Line	:	6456 N 107TH CT
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1190
Country	:	US
Telephone Number	:	402-213-0439
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 N ADAMS ST STE 8
Second Line	:
City	:	PAPILLION
State	:	NE
Zip	:	68046-3080
Country	:	US
Telephone Number	:	531-444-1963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	02/11/2025

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