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General NPI Number Information
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NPI Number | 1750693990
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Entity Type | Individual
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Provider Name | ERIN BAGLEY AUD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2010
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 1001 VINE ST
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City | LIVERPOOL
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State | NY
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Zip | 13088-4523
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Country | US
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Telephone | 315-451-7221
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Fax |
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Provider Business Mailing Address
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Address Line | 9369 JACOB LN
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City | BREWERTON
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State | NY
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Zip | 13029-9449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 015507-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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