Provider Demographics
NPI:1043390891
Name:RAGAN, PENELOPE BOYETTE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:BOYETTE
Last Name:RAGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:BOYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:104 CALLAWAY CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-5543
Mailing Address - Country:US
Mailing Address - Phone:919-580-9395
Mailing Address - Fax:
Practice Address - Street 1:205 GLEN OAK DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1705
Practice Address - Country:US
Practice Address - Phone:919-734-1773
Practice Address - Fax:919-580-0023
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210938Medicaid