Provider Demographics
NPI:1215087226
Name:RAGAN, MICHAELA A (MED,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:A
Last Name:RAGAN
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 SW RIVER ST
Mailing Address - Street 2:
Mailing Address - City:FORT OGDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34267
Mailing Address - Country:US
Mailing Address - Phone:863-494-2911
Mailing Address - Fax:
Practice Address - Street 1:411 COMMERCIAL CT
Practice Address - Street 2:STE F
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1650
Practice Address - Country:US
Practice Address - Phone:941-468-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890603300Medicaid