Healthcare Provider Details

I. General information

NPI: 1720862774
Provider Name (Legal Business Name): GRACE HAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11780 PIPPIN RD
CINCINNATI OH
45231-1158
US

IV. Provider business mailing address

11083 HAMILTON AVE
CINCINNATI OH
45231-1409
US

V. Phone/Fax

Practice location:
  • Phone: 513-825-7070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.15947
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20232535-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: