Healthcare Provider Details

I. General information

NPI: 1922925056
Provider Name (Legal Business Name): AMANDA HAGEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E JACKSON ST
SIOUX FALLS SD
57108-3522
US

IV. Provider business mailing address

7446 S LOUISE AVE APT 306
SIOUX FALLS SD
57108-5980
US

V. Phone/Fax

Practice location:
  • Phone: 605-759-8466
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: