Provider Demographics
NPI:1235168196
Name:MILROY, DAGMAR WEBER (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAGMAR
Middle Name:WEBER
Last Name:MILROY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4821 BURLINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8135
Mailing Address - Country:US
Mailing Address - Phone:727-322-5102
Mailing Address - Fax:727-528-5817
Practice Address - Street 1:4821 BURLINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8135
Practice Address - Country:US
Practice Address - Phone:727-322-5102
Practice Address - Fax:727-528-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist