DR. JODY LYNN HAGEN (NPI# 1962405563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962405563 |
| Entity Type | Individual |
| Full Name | DR. JODY LYNN HAGEN |
| Credential | PHD |
| Practice Address |
10515 W Markham St Suite B1 Little Rock AR 72205-2139 |
| Mailing Address |
Po Box 206 Mabelvale AR 72103-0206 |
| Practice Telephone | 5018230589 |
| Practice Fax Number | 5012551446 |
| Mailing Telephone | 5018230589 |
| Mailing Fax Number | 5012551446 |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-01-20 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | 2006010348 | MO | Behavioral Health & Social Service Providers |
| N | 103G00000X | Clinical Neuropsychologist | 04-16P | AR | Behavioral Health & Social Service Providers |
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
04-16P | AR | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | BLUE CROSS/BLUE SHIELD | 5Y075 | 01 |
| Street Address |
10515 W MARKHAM ST SUITE B1 |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72205-2139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104299080 | Nicole Bailey | Specialist/Technologist | 10515 W Markham St, E-1, Little Rock, AR 72205-2297 | 2015-11-02 |
| 1356779367 | Freedom Mobility, LLC | Durable Medical Equipment & Medical Supplies | 10515 W Markham St, Soho Centre F1, Little Rock, AR 72205-2297 | 2013-10-30 |
| 1891036190 | Tharwat Lovett | Behavioral Analyst | 10515 W Markham St, Suite E3, Little Rock, AR 72205-2297 | 2013-03-12 |
| 1467714089 | Kelly Chapin Moore | Social Worker | 10515 W Markham St, Ste. I-6, Little Rock, AR 72205-2297 | 2012-06-10 |
| 1164780391 | Angela Bowen | Counselor | 10515 W Markham St, Suite I-6, Little Rock, AR 72205-2297 | 2012-04-25 |
| 1477810802 | The Bowen Wellness Center | Counselor | 10515 W Markham St, Little Rock, AR 72205-2297 | 2012-04-23 |
| 1992072136 | Howard Psychology Consulting Services Pa | Psychologist | 10515 W Markham St, Suite B3, Little Rock, AR 72205-2139 | 2011-11-16 |
| 1639463037 | Lindsay Christine Hoelzeman | Speech-Language Pathologist | 10515 W Markham St, Little Rock, AR 72205-2297 | 2011-06-02 |
| 1891087078 | Shannon Westmoreland Clark | Behavioral Analyst | 10515 W Markham St, Suite E3, Little Rock, AR 72205-2139 | 2011-05-06 |
| 1720314016 | Let's Talk Therapy Services, Inc. | Speech-Language Pathologist | 10515 W Markham St, Suite K-2, Little Rock, AR 72205-2139 | 2009-10-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932719465 | Darleisha Renee Stigall | Behavior Technician | 1210 Aldersdate Rd, Little Rock, AR 72205 | 2020-08-10 |
| 1316563638 | Unknown Amisha | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot #634, University of Arkansas, Little Rock, AR 72205 | 2020-06-23 |
| 1225667272 | Ann-marie Frances Hayre | Student in an Organized Health Care Education/Training Program | 4310 West Markham, Slot 589, Little Rock, AR 72205 | 2020-04-02 |
| 1952930075 | Alexandria Leigh Smith | Student in an Organized Health Care Education/Training Program | 4301 West Markham St, Slot 531, Little Rock, AR 72205 | 2020-04-02 |
| 1093353922 | Phil Fagala | Pharmacist | 614 North Beechwood, Little Rock, AR 72205 | 2019-12-10 |
| 1295391688 | Home To Community Living, Inc | Physical Therapist | 10201 W Markham Street Pulaski, Little Rock, AR 72205 | 2019-05-12 |
| 1669933693 | Sandy Louise Webb | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 530, Little Rock, AR 72205 | 2019-03-31 |
| 1457812828 | Vincent Battafarano | Student in an Organized Health Care Education/Training Program | 4301 West Markham, Slot 602, Little Rock, AR 72205 | 2019-03-28 |
| 1063978922 | Franks Pediatric Occupational Therapy LLC | Occupational Therapist | 5516 C St, Little Rock, AR 72205 | 2019-02-15 |
| 1497210199 | Integrative Counseling Center LLC | Counselor | 10515 W Markham St Ste D3, Little Rock, AR 72205 | 2019-02-06 |
| Find all providers in zip 72205 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043630734 | The Sage Center for Trauma and Wellness, Pllc | Psychologist | 2725 Cantrell Rd Ste 105, Little Rock, AR 72202-2044 | 2014-04-21 |
| 1134468895 | Brian Anderson | Psychologist | 1100 N University Ave Ste 108, Little Rock, AR 72207-6356 | 2013-01-31 |
| 1427300532 | Joy R. Pemberton | Psychologist | 4301 W. Markham, #554, Psychiatric Research Institute, Uams, Little Rock, AR 72205 | 2012-10-12 |
| 1548577521 | Laura Jane Gambone Nobles | Psychologist | 2723 Foxcroft Rd Ste 202a, Little Rock, AR 72227-6522 | 2010-09-11 |
| 1083858005 | George K. Simon Jr. | Psychologist | 1 Innwood Cir Ste 124, Little Rock, AR 72211-2448 | 2009-04-21 |
| 1730356825 | Tisha Lee Deen | Psychologist | 2723 Foxcroft Rd Ste 202, Little Rock, AR 72227-6522 | 2008-05-08 |
| 1205000403 | Meagan Rae Mcpherson | Psychologist | 10515 W Markham St Ste E3, Little Rock, AR 72205-2139 | 2008-04-17 |
| 1366635518 | Daniel John Broderick | Psychologist | 5 Chalamont Ct, Little Rock, AR 72223-5511 | 2007-08-21 |
| 1881894806 | Tracie L. Pasold | Psychologist | 800 Marshall St # 512-9, Dept. of Pediatrics, Section of Adolescent Medicine, Little Rock, AR 72202-3510 | 2007-07-18 |
| 1306976477 | Clinical Psychology Services, Inc. | Psychologist | 18 Corporate Hill Dr Ste 205, Little Rock, AR 72205-4541 | 2007-03-06 |
| Find all providers in LITTLE ROCK | ||||
| City | LITTLE ROCK |
| Zip Code | 72205 |
Please comment or provide details below to improve the information on DR. JODY LYNN HAGEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.