Active NPI
Renee Ann Fagen, PSY.D.
- Clinical Psychologist
- Sioux City, IA
National Provider Identifier
1619456910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 088631
- Practice address
- 1551 Indian Hills Dr
Sioux City, IA 51104-1859 - Phone
- (712) 258-4700
- Fax
- (712) 258-4777
- NPI assigned
- Aug 8, 2018
- Last updated
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 088631 | IA | Primary |
Addresses
Primary practice location
1551 Indian Hills Dr
Sioux City, IA 51104-1859
Mailing address
200 E Ash St
Cleghorn, IA 51014-7724
Phone (515) 418-7717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 088631 | IA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533686400000",
"number": "1619456910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E ASH ST",
"city": "CLEGHORN",
"state": "IA",
"postal_code": "510147724",
"telephone_number": "515-418-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1551 INDIAN HILLS DR",
"city": "SIOUX CITY",
"state": "IA",
"postal_code": "511041859",
"telephone_number": "712-258-4700",
"fax_number": "712-258-4777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGEN",
"first_name": "RENEE",
"middle_name": "ANN",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-08",
"last_updated": "2018-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "088631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.