MEDICARE: CAROLINE CULWELL BAGNASCO CCC-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	0004115	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6242	OTHER	TN	BOARD OF COMMUNICATION DISORDERS AND SCIENCES

General Provider Information

NPI Number	:	1104310218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE CULWELL BAGNASCO CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 5209
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37802-5209
Country	:	US
Telephone Number	:	865-982-3400
Fax Number	:	865-238-2034

Provider Business Practice Location Address
First Line	:	1001 GRAND AVE UNIT 5
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3642
Country	:	US
Telephone Number	:	970-665-4744
Fax Number	:

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

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	05/08/2024

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Directions to “ CAROLINE CULWELL BAGNASCO CCC-SLP” Practice Location

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