Provider Demographics
NPI:1760774780
Name:BARGAS, LORI R
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:BARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 GLADES ROAD
Mailing Address - Street 2:EDU BLD #47 / COMM SCIENCE & DISO
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-297-6074
Mailing Address - Fax:
Practice Address - Street 1:777 GLADES ROAD
Practice Address - Street 2:EDU BLD #47 / COMM SCIENCE & DISORDERS
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-297-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA328235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist