Healthcare Provider Details

I. General information

NPI: 1235168196
Provider Name (Legal Business Name): DAGMAR WEBER MILROY M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 BURLINGTON AVE N
ST PETERSBURG FL
33713-8135
US

IV. Provider business mailing address

4821 BURLINGTON AVE N
ST PETERSBURG FL
33713-8135
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-5102
  • Fax: 727-528-5817
Mailing address:
  • Phone: 727-322-5102
  • Fax: 727-528-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA2822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: