Basic Information
| Provider Information | |||||||||
| NPI: | 1174720320 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGEN | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2018 W RIVERSIDE AVE | ||||||||
| Address2: | APT. A | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992011411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096240528 | ||||||||
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| Practice Location | |||||||||
| Address1: | 414 S UNIVERSITY RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992065555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5099244650 | ||||||||
| FaxNumber: | 5092280851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL00003981 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP-1108 | ID | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.