Provider Demographics
NPI:1932833878
Name:AG SPEECH THERAPY INC.
Entity Type:Organization
Organization Name:AG SPEECH THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:GOTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:916-542-0083
Mailing Address - Street 1:10525 SKYNYRD WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2162
Mailing Address - Country:US
Mailing Address - Phone:916-542-0083
Mailing Address - Fax:
Practice Address - Street 1:10525 SKYNYRD WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-2162
Practice Address - Country:US
Practice Address - Phone:916-542-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech