Provider Demographics
NPI:1013401819
Name:SPANNAGEL, HILARY HAYASHI
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:HAYASHI
Last Name:SPANNAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 COSTERO AISLE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5943
Mailing Address - Country:US
Mailing Address - Phone:310-927-4894
Mailing Address - Fax:
Practice Address - Street 1:1929 MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6524
Practice Address - Country:US
Practice Address - Phone:949-229-5709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27923OtherSPEECH PATHOLOGIST LICENSE