Individual
MRS. ELAINE TUCKER HAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA SLP CCC
Contact information
Practice address
5804 GRANBY ST, NORFOLK, VA 23505-4813
(757) 692-6574
Mailing address
503 GARDEN LN, PALMYRA, VA 22963-4285
(757) 692-6574
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004878
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1235456633
—
VA
Enumeration date
04/23/2010
Last updated
04/18/2018
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