Provider Demographics
NPI:1386999746
Name:GORA, VIRGINIA RAGSDALE (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:RAGSDALE
Last Name:GORA
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 S ATLANTIC AVE
Mailing Address - Street 2:APT #3405
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-4573
Mailing Address - Country:US
Mailing Address - Phone:386-428-5319
Mailing Address - Fax:
Practice Address - Street 1:1104 BEVILLE RD.
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-416-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist