Individual
TERESA JO HAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
703 MACEDONIA ST, MAYFIELD, KY 42066-3711
(270) 970-4652
Mailing address
703 MACEDONIA ST, MAYFIELD, KY 42066-3711
(270) 970-4652
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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