Provider Demographics
NPI:1598912396
Name:O'HAGAN, RACHEL SUZANNE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:SUZANNE
Last Name:O'HAGAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3376 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-1928
Mailing Address - Country:US
Mailing Address - Phone:610-392-4339
Mailing Address - Fax:610-865-1289
Practice Address - Street 1:3376 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-1928
Practice Address - Country:US
Practice Address - Phone:610-392-4339
Practice Address - Fax:610-865-1289
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006090L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015094300001Medicaid