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General NPI Number Information
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NPI Number | 1780474502
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Entity Type | Organization
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Legal Business Name | HAGAN REHABILITATION
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 515 NW 66TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64118-3218
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Country | US
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Telephone | 636-614-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 515 NW 66TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64118-3218
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Country | US
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Telephone | 636-614-8057
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Fax |
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Authorized Official
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Title or Position | CCC- SLP
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Name | SAMANTHA HAGAN
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Credential | M.S.
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Telephone | 636-614-8057
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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 |
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License Number State |
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