MEDICARE: AMANDA HAGEN

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	235Z00000X	Speech-Language Pathologist		SD

General Provider Information

NPI Number	:	1922925056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HAGEN

Provider Business Mailing Address
First Line	:	7446 S LOUISE AVE APT 306
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5980
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 E JACKSON ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-3522
Country	:	US
Telephone Number	:	605-759-8466
Fax Number	:

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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Directions to “ AMANDA HAGEN ” Practice Location

Language	Start Address	Practice Location

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