Individual
KELLY J HAGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
442 N WESTHILL BLVD, APPLETON, WI 54914-5715
(920) 750-7000
(920) 364-2451
Mailing address
444 N WESTHILL BLVD, APPLETON, WI 54914-5715
(920) 750-7000
(920) 364-2451
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
130696121
WI
104100000X
Social Worker
Primary
9211-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100071118
—
WI
Enumeration date
09/11/2017
Last updated
05/29/2019
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