Provider Demographics
NPI:1073964813
Name:HAGLIN, TERESSA (MA)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:
Last Name:HAGLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:
Other - Last Name:PAWLOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 W RAINBOW ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2006
Mailing Address - Country:US
Mailing Address - Phone:218-727-7500
Mailing Address - Fax:
Practice Address - Street 1:208 W RAINBOW ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2006
Practice Address - Country:US
Practice Address - Phone:218-727-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4310-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist