Individual
MS. BEVERLY JEAN HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 11TH STREET, SUITE B100, MODESTO, CA 95354-2324
(209) 567-4153
Mailing address
2900 W RUMBLE RD, #20, MODESTO, CA 95350-0193
(209) 236-1025
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/30/2007
Last updated
07/08/2007
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