Provider Demographics
NPI:1215437538
Name:RAGLAND, JACQUELYN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:RAGLAND
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 TAVERNOR LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7200
Mailing Address - Country:US
Mailing Address - Phone:434-973-5551
Mailing Address - Fax:
Practice Address - Street 1:1000 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5908
Practice Address - Country:US
Practice Address - Phone:434-245-2527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2203000553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist