Provider Demographics
NPI:1780698597
Name:HAGUE, KEVIN W (MA, CCC-A)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:W
Last Name:HAGUE
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 W. GRANDRIDGE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-735-7461
Mailing Address - Fax:509-783-8167
Practice Address - Street 1:8102 W. GRANDRIDGE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-735-7461
Practice Address - Fax:509-783-8167
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACD00000983231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8338394Medicaid
WA8338394Medicaid