Healthcare Provider Details

I. General information

NPI: 1366117475
Provider Name (Legal Business Name): SKYLER PHELPS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17706 I 30
BENTON AR
72019-2907
US

IV. Provider business mailing address

429 WISTERIA DR
BAUXITE AR
72011-8932
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-4414
  • Fax:
Mailing address:
  • Phone: 870-308-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: