1043733280 NPI number — MRS. AINSLEY P. VERGARA M.ED., CCC-SLP

Table of content: MRS. AINSLEY P. VERGARA M.ED., CCC-SLP (NPI 1043733280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043733280 NPI number — MRS. AINSLEY P. VERGARA M.ED., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERGARA
Provider First Name:
AINSLEY
Provider Middle Name:
P.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
P
Provider Other First Name:
AINSLEY
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., CF-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043733280
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 HIDDEN SPRING WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30605-5746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-357-5353
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 CARLTON ST.
Provider Second Line Business Practice Location Address:
593 ADERHOLD
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-542-4598
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP10644 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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