Provider Demographics
NPI:1477443059
Name:HAGOOD, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HAGOOD
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 BALLENTINE ST.
Mailing Address - Street 2:APARTMENT 11
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4696
Mailing Address - Country:US
Mailing Address - Phone:314-705-6419
Mailing Address - Fax:
Practice Address - Street 1:3515 PARK AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2532
Practice Address - Country:US
Practice Address - Phone:816-418-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4141235Z00000X
MO2025027562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist