Courtney Lynne Fagan, M.S. CCC-SLP, QOM

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

21174 Issued in FL

Practice address

1700 N McMullen Booth Rd Ste D4
Clearwater, FL 33759-2129

Phone

(727) 458-3902

NPI assigned

Mar 14, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1184183642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 N MCMULLEN BOOTH RD STE D4",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337592129",
            "telephone_number": "727-458-3902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 N MCMULLEN BOOTH RD STE D4",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337592129",
            "telephone_number": "727-458-3902"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6323 Memorial Hwy",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336154509",
            "country_code": "US",
            "telephone_number": "727-458-3902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "COURTNEY",
        "middle_name": "LYNNE",
        "credential": "M.S. CCC-SLP, QOM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-14",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "21174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Clearwater, FL
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.