Provider Demographics
NPI:1174805311
Name:HAGADORN, SHARON TRACEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:TRACEY
Last Name:HAGADORN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:SHARON
Other - Middle Name:TRACEY
Other - Last Name:HEYWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:8788 RIVER WATCH
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2005
Mailing Address - Country:US
Mailing Address - Phone:315-303-5712
Mailing Address - Fax:
Practice Address - Street 1:8788 RIVER WATCH
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2005
Practice Address - Country:US
Practice Address - Phone:315-303-5712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist