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General NPI Number Information
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NPI Number | 1245770361
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Entity Type | Individual
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Provider Name | KATELYN HAGERTY
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Gender | Female
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 4908 FRANKLIN AVE
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City | DES MOINES
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State | IA
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Zip | 50310-1901
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Country | US
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Telephone | 515-280-4903
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Fax | 515-883-2683
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Provider Business Mailing Address
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Address Line | 200 SE WESTGATE DR
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City | WAUKEE
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State | IA
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Zip | 50263-8263
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Country | US
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Telephone | 319-750-2552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 007990
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License Number State | IA
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