Provider Demographics
NPI:1497438055
Name:AGNEW, KARLIE RAE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:RAE
Last Name:AGNEW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:RAE
Other - Last Name:TECULVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1729 LIVVY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1729 LIVVY LN
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6663
Practice Address - Country:US
Practice Address - Phone:716-499-7389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3455235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist