Healthcare Provider Details

I. General information

NPI: 1770619645
Provider Name (Legal Business Name): BALD KNOB SPECIAL SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W PARK AVE
BALD KNOB AR
72010-3162
US

IV. Provider business mailing address

103 W PARK AVE
BALD KNOB AR
72010-3162
US

V. Phone/Fax

Practice location:
  • Phone: 501-724-5015
  • Fax: 501-724-6253
Mailing address:
  • Phone: 501-724-5015
  • Fax: 501-724-6253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateAR

VIII. Authorized Official

Name: MRS. STACY SANDERS
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: SLP
Phone: 501-724-3714