Provider Demographics
NPI:1053576330
Name:HAGUE, CHRISTINE LYNN (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:HAGUE
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:LYNN
Other - Last Name:GEOGHEGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:1 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4213
Mailing Address - Country:US
Mailing Address - Phone:516-877-4850
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4213
Practice Address - Country:US
Practice Address - Phone:516-877-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016839-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist