Provider Demographics
NPI:1033478615
Name:HAGAN, DANA NICOLE (MA CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:NICOLE
Last Name:HAGAN
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:NICOLE
Other - Last Name:MESKOWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLP
Mailing Address - Street 1:101 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-4329
Mailing Address - Country:US
Mailing Address - Phone:631-274-4310
Mailing Address - Fax:
Practice Address - Street 1:101 LAKE AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4329
Practice Address - Country:US
Practice Address - Phone:631-274-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012298235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist