Individual
MRS. KIMEKO JEAN HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S, SAC-IT
Contact information
Practice address
4000 W SPENCER ST, APPLETON, WI 54914-4015
(920) 735-9010
(920) 735-9050
Mailing address
13 NORTH GREVES COURT, APPLETON, WI 54914
(920) 993-9661
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
14280-130
WI
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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