Healthcare Provider Details

I. General information

NPI: 1841623287
Provider Name (Legal Business Name): KE'ANDRA L HAGANS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 N HOLTON ST STE 400
MILWAUKEE WI
53212-1064
US

IV. Provider business mailing address

3207 N 44TH ST
MILWAUKEE WI
53216-3541
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-1535
  • Fax: 414-964-0102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8196-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: