Provider Demographics
NPI:1316066236
Name:HADDER, MICHAEL TRENT
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TRENT
Last Name:HADDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 LAKE GERALD CIR
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:AL
Mailing Address - Zip Code:36258-5717
Mailing Address - Country:US
Mailing Address - Phone:256-488-5866
Mailing Address - Fax:
Practice Address - Street 1:105 JOHNSON AVE N
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2464
Practice Address - Country:US
Practice Address - Phone:256-362-7716
Practice Address - Fax:256-362-7715
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2151237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist