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NPI Code Detail

MEDICARE: MRS. TRACI LYNN HAGEN MSW, LSW

MEDICARE: MRS. TRACI LYNN HAGEN MSW, LSW
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
1104100000XSocial WorkerS0025566OH

General Provider Information

NPI Number : 1396882601
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TRACI LYNN HAGEN MSW, LSW
Provider Business Mailing Address
First Line : 990 EMORY AVE
Second Line :
City : AKRON
State : OH
Zip : 44310-1709
Country : US
Telephone Number : 330-633-0781
Fax Number :
Provider Business Practice Location Address
First Line : 3500 CARNEGIE AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44115-2641
Country : US
Telephone Number : 440-260-8453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 10/16/2012

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