Provider Demographics
NPI:1073054763
Name:HOAGLAND, MICHAEL S (ACA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HOAGLAND
Suffix:
Gender:M
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CHERRYBARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1804
Mailing Address - Country:US
Mailing Address - Phone:859-278-9568
Mailing Address - Fax:859-277-8608
Practice Address - Street 1:120 CHERRYBARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1804
Practice Address - Country:US
Practice Address - Phone:859-278-9568
Practice Address - Fax:859-277-8608
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY102715237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist