Provider Demographics
NPI:1245396043
Name:RAGAN, TERRY J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:RAGAN
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 1:526 PULASKI ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2347
Mailing Address - Country:US
Mailing Address - Phone:706-255-2871
Mailing Address - Fax:
Practice Address - Street 1:526 PULASKI ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2347
Practice Address - Country:US
Practice Address - Phone:706-255-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist