Provider Demographics
NPI:1386196285
Name:HASTINGS, SHERRY MACGREGOR (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MACGREGOR
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 MONROE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3649
Mailing Address - Country:US
Mailing Address - Phone:715-379-2615
Mailing Address - Fax:
Practice Address - Street 1:594 N GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-6748
Practice Address - Country:US
Practice Address - Phone:715-379-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2644235Z00000X
CAMFC31562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist