Provider Demographics
NPI:1306043963
Name:HAGANS, PAUL MATTHEW (SLP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MATTHEW
Last Name:HAGANS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 SHEPHERD ST
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-7707
Mailing Address - Country:US
Mailing Address - Phone:606-886-3917
Mailing Address - Fax:
Practice Address - Street 1:571 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9248
Practice Address - Country:US
Practice Address - Phone:606-349-6182
Practice Address - Fax:606-349-5962
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist