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Individual

LAURA HAGEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
35 SOUTHPOINTE DR, GREENVILLE, SC 29607-5956
(330) 268-0421
Mailing address
35 SOUTHPOINTE DR, GREENVILLE, SC 29607-5956
(330) 268-0421

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6552
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6552
SC STATE LICENSURE NUMBER
Enumeration date
05/23/2019
Last updated
05/23/2019
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