Provider Demographics
NPI:1902060346
Name:AGAN, JOSEPH (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:AGAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SW MIAMI LOOP
Mailing Address - Street 2:APT 10
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-7783
Mailing Address - Country:US
Mailing Address - Phone:479-283-1698
Mailing Address - Fax:
Practice Address - Street 1:606 NORTH RAZORBACK ROAD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-575-2070
Practice Address - Fax:479-575-4507
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168216721Medicaid