Provider Demographics
NPI:1972626570
Name:HAGSTROM, FRAN (PHD)
Entity type:Individual
Prefix:DR
First Name:FRAN
Middle Name:
Last Name:HAGSTROM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ARKANSAS AVE
Mailing Address - Street 2:SPEECH & HEARING CLINIC
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-1201
Mailing Address - Country:US
Mailing Address - Phone:479-575-4910
Mailing Address - Fax:479-575-4507
Practice Address - Street 1:410 ARKANSAS AVE
Practice Address - Street 2:SPEECH & HEARING CLINIC
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-1201
Practice Address - Country:US
Practice Address - Phone:479-575-4910
Practice Address - Fax:479-575-4507
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist