Individual
COURTNEY LYNNE FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP, QOM
Contact information
Practice address
1700 N MCMULLEN BOOTH RD STE D4, CLEARWATER, FL 33759-2129
(727) 458-3902
Mailing address
1700 N MCMULLEN BOOTH RD STE D4, CLEARWATER, FL 33759-2129
(727) 458-3902
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
21174
FL
Other
Enumeration date
03/14/2019
Last updated
08/19/2024
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