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NPI Code Detail

MEDICARE: BLAKE CHILDERS

MEDICARE: BLAKE CHILDERS
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
1235Z00000XSpeech-Language PathologistSP#2670AR

General Provider Information

NPI Number : 1407256423
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE CHILDERS
Provider Business Mailing Address
First Line : 1000 W BULLDOG BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-4714
Country : US
Telephone Number : 479-973-8639
Fax Number :
Provider Business Practice Location Address
First Line : 1000 W BULLDOG BLVD
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72701-4714
Country : US
Telephone Number : 479-973-8639
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2014
Last Update Date : 08/27/2014

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Directions to “ BLAKE CHILDERS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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