Provider Demographics
NPI:1043733280
Name:VERGARA, AINSLEY P (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AINSLEY
Middle Name:P
Last Name:VERGARA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:AINSLEY
Other - Middle Name:NICOLE
Other - Last Name:P
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, CF-SLP
Mailing Address - Street 1:209 HIDDEN SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-5746
Mailing Address - Country:US
Mailing Address - Phone:478-357-5353
Mailing Address - Fax:
Practice Address - Street 1:110 CARLTON ST.
Practice Address - Street 2:593 ADERHOLD
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602
Practice Address - Country:US
Practice Address - Phone:706-542-4598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP10644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist