Provider Demographics
NPI:1669861399
Name:AGAN, CAROL ANN (SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:AGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3291 S THOMPSON ST
Mailing Address - Street 2:SUITE C103
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7043
Mailing Address - Country:US
Mailing Address - Phone:479-750-3535
Mailing Address - Fax:479-750-3539
Practice Address - Street 1:3291 S THOMPSON ST
Practice Address - Street 2:SUITE C103
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7043
Practice Address - Country:US
Practice Address - Phone:479-750-3535
Practice Address - Fax:479-750-3539
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist