| Doctor Name: | MISS AMANDA GEORGEANN HAGMAN |
| NPI Number: | 1073828521 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 11449 S 49th West Ave Sapulpa, OK - 740668947 |
| Business Phone Number: | 9187061847 |
| Business Fax Number: | |
| Mailing Address: | 11449 S 49th West Ave, SAPULPA |
| State: | OK |
| Postal Code: | 740668947 |
| Phone Number: | 9187061847 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2010 |
| NPI Last Update Date: | 08/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TR0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |