Provider Demographics
NPI:1760900500
Name:AGB SPEECH THERAPY
Entity Type:Organization
Organization Name:AGB SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT AGB SPEECH THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BONKOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:501-743-8497
Mailing Address - Street 1:471 HERITAGE PARK BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5623
Mailing Address - Country:US
Mailing Address - Phone:501-743-8497
Mailing Address - Fax:844-854-4658
Practice Address - Street 1:471 HERITAGE PARK BLVD STE 5
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5623
Practice Address - Country:US
Practice Address - Phone:501-743-8497
Practice Address - Fax:844-854-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8951152-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396076113OtherNPI