Healthcare Provider Details

I. General information

NPI: 1043448970
Provider Name (Legal Business Name): ASHLEY LYNNE HAGEN MS, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ASHLEY LYNNE FANGMAN

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47050 COUNTY ROAD X
SOLDIERS GROVE WI
54655-8551
US

IV. Provider business mailing address

47050 COUNTY ROAD X
SOLDIERS GROVE WI
54655-8551
US

V. Phone/Fax

Practice location:
  • Phone: 608-735-4311
  • Fax: 608-735-4317
Mailing address:
  • Phone: 608-735-4311
  • Fax: 608-735-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: