=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427674456
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRITTANY HAGEN APSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2020
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 511 MADISON AVE
-----------------------------------------------------
City | FORT ATKINSON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53538-1444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-541-3078
-----------------------------------------------------
Fax | 920-817-3831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 MADISON AVE
-----------------------------------------------------
City | FORT ATKINSON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53538-1444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-541-3078
-----------------------------------------------------
Fax | 920-817-3831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 128875-121
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------