MEDICARE: AGGIE WEBER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP13470	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417019225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGGIE WEBER

Provider Business Mailing Address
First Line	:	1301 E BIDWELL ST STE 201
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3565
Country	:	US
Telephone Number	:	800-900-8491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 E BIDWELL ST STE 201
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3565
Country	:	US
Telephone Number	:	800-900-8491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	02/18/2010

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Directions to “ AGGIE WEBER ” Practice Location

Language	Start Address	Practice Location

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