Healthcare Provider Details

I. General information

NPI: 1467070581
Provider Name (Legal Business Name): MACY MICHELLE TREVILLION M.S. CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 NW 7TH ST STE 2
BENTONVILLE AR
72712-4565
US

IV. Provider business mailing address

PO BOX 10310
CONWAY AR
72034-0004
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-9838
  • Fax:
Mailing address:
  • Phone: 501-472-9826
  • Fax:

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:
Title or Position:
Credential:
Phone: