Individual
MRS. JENNA L HAGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCLS
Contact information
Practice address
550 N KINGSBURY ST APT 209, CHICAGO, IL 60654-5757
(810) 923-4120
Mailing address
550 N KINGSBURY ST APT 209, CHICAGO, IL 60654-5757
(810) 923-4120
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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