Healthcare Provider Details

I. General information

NPI: 1497664254
Provider Name (Legal Business Name): BENJAMIN IAN HAGER WA.MA.70100167
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: IAN HAGER

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 SE CHKALOV DR APT 49
VANCOUVER WA
98683-5277
US

IV. Provider business mailing address

PO BOX 1082
WOODLAND WA
98674-1100
US

V. Phone/Fax

Practice location:
  • Phone: 912-660-9873
  • Fax:
Mailing address:
  • Phone: 912-660-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA.70100167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: