Provider Demographics
NPI:1669921060
Name:HAGERTY, ATHENA (MS)
Entity type:Individual
Prefix:MS
First Name:ATHENA
Middle Name:
Last Name:HAGERTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 BELDEN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1168
Mailing Address - Country:US
Mailing Address - Phone:602-460-9524
Mailing Address - Fax:
Practice Address - Street 1:883 BELDEN ST APT 4
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1168
Practice Address - Country:US
Practice Address - Phone:602-460-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP20818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist