MEDICARE: KE'ANDRA L HAGANS MSW, APSW

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	104100000X	Social Worker	128336-121	WI

General Provider Information

NPI Number	:	1841623287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KE'ANDRA L HAGANS MSW, APSW

Provider Business Mailing Address
First Line	:	3207 N 44TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 N HOLTON ST STE 400
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1064
Country	:	US
Telephone Number	:	414-810-1535
Fax Number	:	414-964-0102

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

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	08/20/2013

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