Healthcare Provider Details

I. General information

NPI: 1528690138
Provider Name (Legal Business Name): LOREN SPERLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 N WALTON BLVD STE 1
BENTONVILLE AR
72712-4302
US

IV. Provider business mailing address

2601 N WALTON BLVD STE 1
BENTONVILLE AR
72712-4302
US

V. Phone/Fax

Practice location:
  • Phone: 479-802-4798
  • Fax: 479-688-0589
Mailing address:
  • Phone: 479-802-4798
  • Fax: 479-688-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-65863
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54424
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: