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NPI Code Detail

MEDICARE: OLIVIA C HAGENESS MS, LPC

MEDICARE: OLIVIA C HAGENESS MS, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor12298-125WI

General Provider Information

NPI Number : 1164101473
Entity Type Code : Individual
Provider Name (Legal Business Name) : OLIVIA C HAGENESS MS, LPC
Provider Business Mailing Address
First Line : 1791 COUNTY HIGHWAY OO
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-5347
Country : US
Telephone Number : 715-797-2770
Fax Number :
Provider Business Practice Location Address
First Line : 1791 COUNTY HIGHWAY OO
Second Line :
City : CHIPPEWA FALLS
State : WI
Zip : 54729-5347
Country : US
Telephone Number : 715-797-2770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 02/03/2026

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