Provider Demographics
NPI:1457627622
Name:BAGLEY, MONICA GUARINO (MCD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:GUARINO
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:MADELINE
Other - Last Name:GUARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD
Mailing Address - Street 1:PO BOX 2013
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-2013
Mailing Address - Country:US
Mailing Address - Phone:205-821-1778
Mailing Address - Fax:985-327-7711
Practice Address - Street 1:1331 OCHSNER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8177
Practice Address - Country:US
Practice Address - Phone:205-821-1778
Practice Address - Fax:985-327-7711
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2383235Z00000X
LA4736235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist