MEDICARE: MS. KAYE LYNN AGNEW SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	599	OK

General Provider Information

NPI Number	:	1700085941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYE LYNN AGNEW SLP

Provider Business Mailing Address
First Line	:	2913 CANTON LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-3659
Country	:	US
Telephone Number	:	405-844-9953
Fax Number	:	405-844-9953

Provider Business Practice Location Address
First Line	:	2913 CANTON LN
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73012-3659
Country	:	US
Telephone Number	:	405-844-9953
Fax Number	:	405-844-9953

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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