Provider Demographics
NPI:1952979817
Name:HAGEMAN, NAOMI ROSE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:ROSE
Last Name:HAGEMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 WARWICK BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-1441
Mailing Address - Country:US
Mailing Address - Phone:402-738-0076
Mailing Address - Fax:
Practice Address - Street 1:4025 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2207
Practice Address - Country:US
Practice Address - Phone:816-492-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist