Mary Elizabeth Hagen, MA/CCC SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

5043 Issued in MN

Practice address

5480 Nathan LN N
Suite 140
Plymouth, MN 55442-1997

Phone

(763) 607-4440

Fax

(763) 553-2933

NPI assigned

Jun 21, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629014378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10715 39TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554411412",
            "telephone_number": "763-607-4440",
            "fax_number": "763-553-2933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5480 NATHAN LN N",
            "address_2": "SUITE 140",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421997",
            "telephone_number": "763-607-4440",
            "fax_number": "763-553-2933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "MA/CCC SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "5043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "46-00932",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "318R0HA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Gust, RN
• Pamela J Gustafson
• Tamera Lynn Haase, PHARMD
• Dean Hadland
• Sandra Hage
• Lauren Joy Hager, APRN, FNP-C
• Michelle Spies Haggerty, MD
• Jeffrey Ryan Halbleib, PT, DPT
• Caitlin Patricia Hall
• Katherine Mary Hall

• Speech-Language Pathologist in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.