JAQULIN FOWLER HAGEDORN (NPI# 1356745467) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356745467 |
| Entity Type | Individual |
| Full Name | JAQULIN FOWLER HAGEDORN |
| Credential | MA, LPC |
| Practice Address |
2830 Corunna Rd Flint MI 48503-3254 |
| Practice Telephone | 8102356812 |
| Mailing Telephone | 8102356812 |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2020-02-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | 6401016327 | MI | Behavioral Health & Social Service Providers |
| Y | 101YP2500X |
Counselor Specialization: Professional |
6401018092 | MI | Behavioral Health & Social Service Providers |
| N | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2700 Robert T Longway Blvd, Flint, MI 485032190 | 8104964955 |
| Street Address |
2830 CORUNNA RD |
| City | FLINT |
| State | MI |
| Zip Code | 48503-3254 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689668725 | Mona Lee Sander | Social Worker | 2830 Corunna Rd, Flint, MI 48503-3254 | 2005-09-05 |
| 1619506680 | Jessica Pitts | Case Manager/Care Coordinator | 2830 Corunna Rd, Flint, MI 48503-3254 | 2020-04-02 |
| 1104464650 | Devon Payne | Counselor | 2830 Corunna Rd, Flint, MI 48503-3254 | 2019-12-16 |
| 1003458589 | Ryan Christopher Ploch | Social Worker | 2830 Corunna Rd, Flint, MI 48503-3254 | 2019-10-16 |
| 1861051617 | Makita Nelson | Case Manager/Care Coordinator | 2830 Corunna Rd, Flint, MI 48503-3254 | 2019-06-06 |
| 1457817637 | Heather Grace Hall | Counselor | 2830 Corunna Rd, Flint, MI 48503-3254 | 2019-02-13 |
| 1518430701 | Kristin Leigh Chevrette | Registered Nurse | 2830 Corunna Rd, Flint, MI 48503-3254 | 2019-01-10 |
| 1124539564 | Brandie Sanders | Social Worker | 2830 Corunna Rd, Flint, MI 48503 | 2017-10-12 |
| 1922526623 | Gregory Scott Thornhill | Psychologist | 2830 Corunna Rd, Flint, MI 48503-3254 | 2017-09-01 |
| 1063934768 | Sierra Horton | Social Worker | 2830 Corunna Rd, Flint, MI 48503-3254 | 2017-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457971640 | Flint Odyssey House Inc. | Community/Behavioral Health | 1219 Martin Luther King Avenue, Flint, MI 48503 | 2020-04-17 |
| 1891265476 | Mary Margaret Woodruff | Health Educator | 411 E. Third St Suite 2, Flint, MI 48503 | 2018-11-27 |
| 1669942223 | Donna Jean Phelps | Behavior Technician | 2284 S Ballenger Highway, Flint, MI 48503 | 2018-11-27 |
| 1588150601 | Dayonna Scott | Social Worker | Hope Network, 2830 Corunna Rd, Flint, MI 48503 | 2018-07-02 |
| 1801388020 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 2284 S Ballenger Hwy Ste F, Flint, MI 48503 | 2018-06-04 |
| 1134610504 | Swathi Gorle | Student in an Organized Health Care Education/Training Program | Hurley Medical Center, 1 Hurley Plaza, Flint, MI 48503 | 2018-05-22 |
| 1881128049 | Kara Garr | Registered Nurse | 805 Tuuri Pl, Flint, MI 48503 | 2017-04-14 |
| 1518405638 | Thomasinia Terrell | Peer Specialist | 422 W Fourth Ave, Flint, MI 48503 | 2017-02-09 |
| 1790231041 | Roslyn Boyce | Technician, Other | 2213 E. Court Street, Flint, MI 48503 | 2016-08-28 |
| 1689120818 | Yasmine Elhefnawy | Student in an Organized Health Care Education/Training Program | One Hurley Plaza 3d West, Flint, MI 48503 | 2016-08-28 |
| Find all providers in zip 48503 | ||||
| Taxonomy Code | 101YP2500X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Professional |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255930640 | Nikki Lynn Moorman | Counselor | 1295 S Linden Rd Ste F, Flint, MI 48532-3498 | 2020-10-18 |
| 1225635568 | Nichole Wright | Counselor | 5294 Timberwood Point Dr, Flint, MI 48532-2265 | 2020-10-08 |
| 1821603549 | Shift Consulting | Counselor | 2425 S Linden Rd Ste D138, Flint, MI 48532-5482 | 2020-09-10 |
| 1730797291 | Lauren Hawkins | Counselor | 18420 Serenity Way, Flint, TX 75762-9625 | 2020-07-20 |
| 1588214068 | Omni Odum | Counselor | 1121 Villa Linde Ct Bldg 39, Flint, MI 48532-3410 | 2019-09-16 |
| 1992357339 | Jennifer E Malone | Counselor | 1328 Williamsburg Rd, Flint, MI 48507-5628 | 2019-07-16 |
| 1073076055 | Michelle Lowder | Counselor | 17238 Pennie Ln, Flint, TX 75762-9148 | 2019-04-08 |
| 1457814550 | Monica Lynn Blackwell | Counselor | 2425 S Linden Rd Ste 134, Flint, MI 48532-5473 | 2019-04-08 |
| 1679080089 | Candace Shuel | Counselor | 2387 S Linden Rd Ste 124, Flint, MI 48532-5487 | 2018-01-08 |
| 1649786500 | Kristen Alexis Bedevian | Counselor | 16735 Gresham Cir # 101, Flint, TX 75762-3510 | 2017-12-14 |
| Find all providers in FLINT | ||||
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| 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.