Healthcare Provider Details

I. General information

NPI: 1619831468
Provider Name (Legal Business Name): ERICA LYNN HAGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 S MAIN ST STE 2
ADRIAN MI
49221-4309
US

IV. Provider business mailing address

2387 E CLEARVIEW DR
ADRIAN MI
49221-3678
US

V. Phone/Fax

Practice location:
  • Phone: 517-312-1711
  • Fax:
Mailing address:
  • Phone: 517-442-5009
  • Fax: 517-442-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: