Individual
PATRICIA M BAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP, BCBA, LBA
Contact information
Practice address
11736 SUNRISE VALLEY DR, RESTON, VA 20191-1444
(908) 216-2593
Mailing address
11736 SUNRISE VALLEY DR, RESTON, VA 20191-1444
(908) 216-2593
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000547
VA
103K00000X
Behavior Analyst
—
—
235Z00000X
Speech-Language Pathologist
2202007683
VA
Other
Enumeration date
01/29/2017
Last updated
03/07/2023
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