MEDICARE: MRS. SUZETTE MARIE HAGER L.C.S.W

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	1041C0700X	Clinical Social Worker	5600139-3501	UT
2	1041C0700X	Clinical Social Worker	C011350	NC

General Provider Information

NPI Number	:	1629389986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZETTE MARIE HAGER L.C.S.W

Provider Business Mailing Address
First Line	:	3017 WELLINGFORD DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-2240
Country	:	US
Telephone Number	:	801-380-8762
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 WELLINGFORD DR
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-2240
Country	:	US
Telephone Number	:	801-380-8762
Fax Number	:

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

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	04/20/2018

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