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1164101473 NPI number — OLIVIA C HAGENESS MS LPC-IT

NPI Number: 1164101473
Health Care Provider/Practitioner: OLIVIA C HAGENESS MS LPC-IT

Information about “1164101473” NPI (OLIVIA C HAGENESS MS LPC-IT) exists in 1164101473 in HTML format HTML  |  1164101473 in plain Text format TXT  |  1164101473 in PDF (Portable Document Format) PDF  |  1164101473 in an XML format XML  formats.

NPI Number : 1164101473 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164101473",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HAGENESS",
    "FirstName": "OLIVIA",
    "MiddleName": "C",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS LPC-IT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "19968 70TH AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHIPPEWA FALLS",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54729-6476",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "715-533-2516",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1791 COUNTY HIGHWAY OO",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHIPPEWA FALLS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54729-5347",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "715-797-2770",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/13/2023",
    "LastUpdateDate": "07/13/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "7210-226",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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