Provider Demographics
NPI:1124200829
Name:HAGEMAN, NANCY JO (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 S FIELDCREST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3210
Mailing Address - Country:US
Mailing Address - Phone:620-532-6001
Mailing Address - Fax:
Practice Address - Street 1:724 NORTH JEFFERSON
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:KS
Practice Address - Zip Code:67025
Practice Address - Country:US
Practice Address - Phone:316-540-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2743235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist