Provider Demographics
NPI:1386398048
Name:HAGUE, CLARICE
Entity type:Individual
Prefix:
First Name:CLARICE
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 1:601 UNDERWOOD ST STE A1A
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3771
Mailing Address - Country:US
Mailing Address - Phone:740-450-1615
Mailing Address - Fax:740-297-7707
Practice Address - Street 1:601 UNDERWOOD ST STE A1A
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3771
Practice Address - Country:US
Practice Address - Phone:740-450-1615
Practice Address - Fax:740-297-7707
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2106271104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker