Provider Demographics
NPI:1902053184
Name:HAGMAN, STACY HICKS (CSW)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:HICKS
Last Name:HAGMAN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2315
Mailing Address - Country:US
Mailing Address - Phone:502-409-1971
Mailing Address - Fax:
Practice Address - Street 1:1227 PAYNE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-2315
Practice Address - Country:US
Practice Address - Phone:502-409-1971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5369104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker