Provider Demographics
NPI:1578312724
Name:HAGEN, SHANIA M (MS)
Entity type:Individual
Prefix:
First Name:SHANIA
Middle Name:M
Last Name:HAGEN
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:SHANIA
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5860 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5903
Mailing Address - Country:US
Mailing Address - Phone:952-767-4200
Mailing Address - Fax:952-767-4211
Practice Address - Street 1:1020 BUDDY HOLLY PLACE
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-3735
Practice Address - Country:US
Practice Address - Phone:952-767-4200
Practice Address - Fax:952-767-4211
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst