Provider Demographics
NPI:1528201910
Name:AGUSTI, ANGIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ANGIE
Middle Name:
Last Name:AGUSTI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 SW 63RD TER
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-2019
Mailing Address - Country:US
Mailing Address - Phone:305-607-6121
Mailing Address - Fax:
Practice Address - Street 1:6440 SW 63RD TER
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-2019
Practice Address - Country:US
Practice Address - Phone:305-607-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist