Provider Demographics
NPI:1346788189
Name:BAGG THERAPY GROUP
Entity type:Organization
Organization Name:BAGG THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGG
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, BCBA, LBA
Authorized Official - Phone:908-216-2593
Mailing Address - Street 1:41161 TURKEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5868
Mailing Address - Country:US
Mailing Address - Phone:908-216-2593
Mailing Address - Fax:
Practice Address - Street 1:41161 TURKEY OAK DR
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5868
Practice Address - Country:US
Practice Address - Phone:908-216-2593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000547103K00000X
VA2202007683235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty