| Keli Hagen Lisw, Pllc | |
|
4403 1st Ave Se Ste 412 Cedar Rapids IA 52402-3221 | |
| (319) 213-2922 | |
| Not Available |
| Full Name | Keli Hagen Lisw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 4403 1st Ave Se Ste 412, Cedar Rapids, Iowa |
| Authorized Official Name and Position | Keli B Hagen (SOLE MEMBER) |
| Authorized Official Contact | 3192132922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keli Hagen Lisw, Pllc 4403 1st Ave Se Ste 412 Cedar Rapids IA 52402-3221 Ph: (319) 213-2922 | Keli Hagen Lisw, Pllc 4403 1st Ave Se Ste 412 Cedar Rapids IA 52402-3221 Ph: (319) 213-2922 |
| NPI Number | 1013529114 |
|---|---|
| Provider Enumeration Date | 08/19/2020 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 6800212549 |
|---|---|
| Medicare Enrollment ID | O20200812002569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013529114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keli B Hagen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497211007 PECOS PAC ID: 2062839004 Enrollment ID: I20200909000120 |
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