Provider Demographics
NPI:1760840458
Name:HACKEL, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HACKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 OLD CLAIRTON RD
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3034
Mailing Address - Country:US
Mailing Address - Phone:412-653-1128
Mailing Address - Fax:
Practice Address - Street 1:448 OLD CLAIRTON RD
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3034
Practice Address - Country:US
Practice Address - Phone:412-653-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist