Provider Demographics
NPI:1336393354
Name:BAERGA, ANNETTE MARIE (MS, SLP, CCC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:MARIE
Last Name:BAERGA
Suffix:
Gender:F
Credentials:MS, SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 PERFECT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32124-2067
Mailing Address - Country:US
Mailing Address - Phone:407-600-4464
Mailing Address - Fax:
Practice Address - Street 1:324 PERFECT DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-2067
Practice Address - Country:US
Practice Address - Phone:407-600-4464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12121894235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5388Medicaid
FL5A9198OtherDEPARTMENT OF HEALTH