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1801083928 NPI number — TERRI A HAGSTROM LCSW

NPI Number: 1801083928
Health Care Provider/Practitioner: TERRI A HAGSTROM LCSW

Information about “1801083928” NPI (TERRI A HAGSTROM LCSW) exists in 1801083928 in HTML format HTML  |  1801083928 in plain Text format TXT  |  1801083928 in PDF (Portable Document Format) PDF  |  1801083928 in an XML format XML  formats.

NPI Number : 1801083928 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801083928",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HAGSTROM",
    "FirstName": "TERRI",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "COHEN",
    "OtherFirstName": "TERRI",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 E MAIN ST",
    "SecondLineMailingAddress": "SUITE C",
    "MailingAddressCityName": "MEDFORD",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97501-6041",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-789-5526",
    "MailingAddressFaxNumber": "541-789-5203",
    "FirstLinePracticeLocationAddress": "600 S 2ND ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CENTRAL POINT",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97502-2704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "541-789-4000",
    "PracticeLocationAddressFaxNumber": "541-789-4023",
    "EnumerationDate": "10/02/2007",
    "LastUpdateDate": "10/02/2007",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "L3914",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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