Provider Demographics
NPI:1033427364
Name:AGHA, NATASHA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:AGHA
Suffix:
Gender:F
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 1:8307 KIMBALL DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2127
Mailing Address - Country:US
Mailing Address - Phone:612-324-9111
Mailing Address - Fax:612-445-9223
Practice Address - Street 1:8307 KIMBALL DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-2127
Practice Address - Country:US
Practice Address - Phone:612-324-9111
Practice Address - Fax:612-445-9223
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9059235Z00000X
WASI60184901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist