Provider Demographics
NPI:1871081661
Name:HAGEN, TYLER J
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:HAGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57274-1518
Mailing Address - Country:US
Mailing Address - Phone:605-881-7493
Mailing Address - Fax:
Practice Address - Street 1:1601 W 44TH PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6376
Practice Address - Country:US
Practice Address - Phone:605-322-3278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer