Provider Demographics
NPI:1780762922
Name:JAGLA, VIRGINIA ABRAHAM (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ABRAHAM
Last Name:JAGLA
Suffix:
Gender:F
Credentials:MS CCC-SLP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8101 W BONNIWELL RD
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-2001
Mailing Address - Country:US
Mailing Address - Phone:262-242-6723
Mailing Address - Fax:
Practice Address - Street 1:9074 N DEERBROOK TRL
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2474
Practice Address - Country:US
Practice Address - Phone:414-355-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI558-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42804900Medicaid