Provider Demographics
NPI:1699371765
Name:AGRE, DANA LYNN (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:AGRE
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MACLE CT
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-7308
Mailing Address - Country:US
Mailing Address - Phone:601-757-2408
Mailing Address - Fax:
Practice Address - Street 1:343 PRADO WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6512
Practice Address - Country:US
Practice Address - Phone:864-270-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.7463SPIN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist