Provider Demographics
NPI:1982840583
Name:BAGG, JOANNA M (MA)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:BAGG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SW PATHFINDER GLN
Mailing Address - Street 2:
Mailing Address - City:FORT WHITE
Mailing Address - State:FL
Mailing Address - Zip Code:32038-8003
Mailing Address - Country:US
Mailing Address - Phone:352-301-9035
Mailing Address - Fax:
Practice Address - Street 1:655 SW PATHFINDER GLN
Practice Address - Street 2:
Practice Address - City:FORT WHITE
Practice Address - State:FL
Practice Address - Zip Code:32038-8003
Practice Address - Country:US
Practice Address - Phone:352-301-9035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist