Individual
LORI ANNE BAGWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
100 W UNION ST, VIENNA, GA 31092-1055
(229) 521-1152
Mailing address
1616 LUCY LN, ROCHELLE, GA 31079-7633
(229) 942-6797
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004943
GA
Other
Enumeration date
08/01/2025
Last updated
08/01/2025
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