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General NPI Number Information
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NPI Number | 1033674684
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Entity Type | Individual
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Provider Name | CHRISTINA HAGEDORN PHD, CCC-SLP, TSSLD
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Gender | Female
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 1800 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3570
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Country | US
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Telephone | 718-982-3681
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Fax |
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Provider Business Mailing Address
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Address Line | 14 ORLEANS CT
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City | COMMACK
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State | NY
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Zip | 11725-4030
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Country | US
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Telephone | 631-566-6843
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 028112-1
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License Number State | NY
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