Provider Demographics
NPI:1073843157
Name:GAGE, CARRIE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 E LONG HILLS RD APT 1513
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8807
Mailing Address - Country:US
Mailing Address - Phone:501-282-1553
Mailing Address - Fax:
Practice Address - Street 1:1200 S REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3774
Practice Address - Country:US
Practice Address - Phone:501-847-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist