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General NPI Number Information
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NPI Number | 1871930347
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Entity Type | Organization
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Legal Business Name | GULF COAST CHILDREN'S SPEECH SERVICES, LLC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 1331 OCHSNER BLVD
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City | COVINGTON
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State | LA
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Zip | 70433-8177
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Country | US
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Telephone | 985-234-0491
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2013
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City | MANDEVILLE
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State | LA
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Zip | 70470-2013
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Country | US
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Telephone | 985-234-0491
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MONICA BAGLEY
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Credential | MCD,CCC-SLP
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Telephone | 985-234-0491
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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 | 4736
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License Number State | LA
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