Provider Demographics
NPI:1912780305
Name:BAGGETT, MERCEDES DESIREE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:DESIREE
Last Name:BAGGETT
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 1:769 PICCADILLY SQ
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-1885
Mailing Address - Country:US
Mailing Address - Phone:951-294-8238
Mailing Address - Fax:
Practice Address - Street 1:451 W CHAMBERS AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-9661
Practice Address - Country:US
Practice Address - Phone:951-925-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist