Healthcare Provider Details

I. General information

NPI: 1366060352
Provider Name (Legal Business Name): ANNA CHRISTINE HAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 COLORADO AVE
GRAND JUNCTION CO
81501-3523
US

IV. Provider business mailing address

1170 COLORADO AVE
GRAND JUNCTION CO
81501-3523
US

V. Phone/Fax

Practice location:
  • Phone: 970-241-2948
  • Fax:
Mailing address:
  • Phone: 970-241-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0016274
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: