Provider Demographics
NPI:1386074011
Name:HAGUE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 LERMITAGE PL
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-5219
Mailing Address - Country:US
Mailing Address - Phone:330-688-1188
Mailing Address - Fax:330-688-1278
Practice Address - Street 1:2910 LERMITAGE PL
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-5219
Practice Address - Country:US
Practice Address - Phone:330-688-1188
Practice Address - Fax:330-688-1278
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 9682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist