Provider Demographics
NPI:1144959503
Name:MIDDLETON, RAGAN DANIELLE (SLPMI)
Entity type:Individual
Prefix:
First Name:RAGAN
Middle Name:DANIELLE
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:SLPMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9512
Mailing Address - Country:US
Mailing Address - Phone:901-461-7633
Mailing Address - Fax:901-867-1603
Practice Address - Street 1:1751 DANCY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1916
Practice Address - Country:US
Practice Address - Phone:901-292-5313
Practice Address - Fax:901-867-1603
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty