Healthcare Provider Details

I. General information

NPI: 1407434186
Provider Name (Legal Business Name): MACKENZIE FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 CENTRAL RD
ARKADELPHIA AR
71923-7244
US

IV. Provider business mailing address

1032 CENTRAL RD
ARKADELPHIA AR
71923-7244
US

V. Phone/Fax

Practice location:
  • Phone: 870-703-0721
  • Fax:
Mailing address:
  • Phone: 870-703-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: