Provider Demographics
NPI:1336474873
Name:HAGOOD, CHRISTINA JOY (MCD, CF-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:JOY
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:MCD, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SOUTHWEST SQUARE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401
Mailing Address - Country:US
Mailing Address - Phone:870-336-0220
Mailing Address - Fax:870-336-0221
Practice Address - Street 1:300 SOUTHWEST SQUARE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:870-336-0221
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR10-0042355S0801X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR186740721Medicaid