MEDICARE: ALICIA HAGGE LCSW, LAC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	0000630	CO
2	1041C0700X	Clinical Social Worker	09923888	CO

General Provider Information

NPI Number	:	1326586116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA HAGGE LCSW, LAC

Provider Business Mailing Address
First Line	:	3050 BROADWAY ST UNIT 3
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3154
Country	:	US
Telephone Number	:	303-653-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 BROADWAY ST UNIT 3
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80304-3154
Country	:	US
Telephone Number	:	303-653-2216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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