Provider Demographics
NPI:1336278068
Name:HAGELSTEIN, PATRICIA (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:HAGELSTEIN
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:NM
Mailing Address - Zip Code:88230-0297
Mailing Address - Country:US
Mailing Address - Phone:505-734-5420
Mailing Address - Fax:585-734-6813
Practice Address - Street 1:100 N. LINCOLN
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NM
Practice Address - Zip Code:88230-0159
Practice Address - Country:US
Practice Address - Phone:505-734-5420
Practice Address - Fax:505-734-6813
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist