Provider Demographics
NPI:1083040836
Name:RAGUSEO, ANA NAZARIO (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:NAZARIO
Last Name:RAGUSEO
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5049
Mailing Address - Country:US
Mailing Address - Phone:803-546-2575
Mailing Address - Fax:
Practice Address - Street 1:500 CONGRESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5049
Practice Address - Country:US
Practice Address - Phone:803-546-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC258827235Z00000X
SC6302235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1942275649Medicaid