Provider Demographics
NPI:1376976860
Name:AGNEW, CORRIE FRANCES (LCSW)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:FRANCES
Last Name:AGNEW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 S PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84104-3232
Mailing Address - Country:US
Mailing Address - Phone:801-388-8574
Mailing Address - Fax:
Practice Address - Street 1:1945 S 1100 E
Practice Address - Street 2:SUITE 202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2369
Practice Address - Country:US
Practice Address - Phone:801-657-0897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7748697-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical