Provider Demographics
NPI:1386914471
Name:HAGLUND, KRYSTLE MARIE (MS SLP/L)
Entity type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:MARIE
Last Name:HAGLUND
Suffix:
Gender:F
Credentials:MS SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 WIGREN RD
Mailing Address - Street 2:
Mailing Address - City:FREWSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14738-9710
Mailing Address - Country:US
Mailing Address - Phone:716-569-4227
Mailing Address - Fax:
Practice Address - Street 1:2 EAST AVE N
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-1302
Practice Address - Country:US
Practice Address - Phone:716-665-6624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist