Healthcare Provider Details

I. General information

NPI: 1073291886
Provider Name (Legal Business Name): RACHEL SUZANNE HAGEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 51ST ST S
FARGO ND
58104-7179
US

IV. Provider business mailing address

680 42ND AVE W
WEST FARGO ND
58078-8276
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-0062
  • Fax: 701-356-5412
Mailing address:
  • Phone: 701-361-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6519
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6519
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: