Provider Demographics
NPI:1760205256
Name:HAGEMOSER, CARI HEATHER (PLMHP)
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:HEATHER
Last Name:HAGEMOSER
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12924 NICHOLAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1254
Mailing Address - Country:US
Mailing Address - Phone:402-680-2397
Mailing Address - Fax:
Practice Address - Street 1:12110 PORT GRACE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3190
Practice Address - Country:US
Practice Address - Phone:402-680-2396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13944101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor