Individual
ANN M HAGENBARTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 N DORYPORT CT, POST FALLS, ID 83854-4696
(208) 691-4058
Mailing address
855 N DORYPORT CT, POST FALLS, ID 83854-4696
(208) 691-4058
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
222Q00000X
—
ID
Enumeration date
02/28/2023
Last updated
08/06/2023
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