Provider Demographics
NPI:1760264964
Name:HAGAN, MICHELE (SLPA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9431 E CORALBELL AVE LOT 191
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-5829
Mailing Address - Country:US
Mailing Address - Phone:480-217-2789
Mailing Address - Fax:
Practice Address - Street 1:1337 S GILBERT RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6074
Practice Address - Country:US
Practice Address - Phone:480-530-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA148772355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant