MEDICARE: BASSETT SPEECH PATHOLOGY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1982050308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASSETT SPEECH PATHOLOGY LLC

Provider Business Mailing Address
First Line	:	3515 SWEETGUM LN
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72764-6614
Country	:	US
Telephone Number	:	479-790-9580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 W VILLAGE PKWY STE 9
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-401-2077
Fax Number	:

Authorized Official
Title or Position	:	M.S. CCC-SLP
Name	:	SHANNON R BASSETT
Credential	:
Telephone Number	:	479-790-9580

Provider Enumeration Date	:	05/05/2016
Last Update Date	:	01/08/2019

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