Provider Demographics
NPI:1730907601
Name:HAGEN, BRENDA JANE (RBT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANE
Last Name:HAGEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JANE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1208 N WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6084
Mailing Address - Country:US
Mailing Address - Phone:253-326-7177
Mailing Address - Fax:
Practice Address - Street 1:1208 N WALNUT AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6084
Practice Address - Country:US
Practice Address - Phone:618-203-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB1126616103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst