Individual
MRS. MARY ELIZABETH HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA/CCC SLP
Contact information
Practice address
5480 NATHAN LN N, SUITE 140, PLYMOUTH, MN 55442-1997
(763) 607-4440
(763) 553-2933
Mailing address
10715 39TH AVE N, PLYMOUTH, MN 55441-1412
(763) 607-4440
(763) 553-2933
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
5043
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
318R0HA
BLUE CROSS BLUE SHIELD
MN
01
—
46-00932
MEDICA
MN
Enumeration date
06/21/2006
Last updated
07/08/2007
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