Provider Demographics
NPI:1710606645
Name:HAGENOW, WENDY (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:HAGENOW
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6834
Mailing Address - Country:US
Mailing Address - Phone:151-276-2362
Mailing Address - Fax:
Practice Address - Street 1:12407 HYMEADOW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1818
Practice Address - Country:US
Practice Address - Phone:512-290-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740323161Medicaid