Healthcare Provider Details

I. General information

NPI: 1336004647
Provider Name (Legal Business Name): HALLIE CREWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 BYRUM RD
BLYTHEVILLE AR
72315-8033
US

IV. Provider business mailing address

206 S BALTIMORE
MANILA AR
72442-8385
US

V. Phone/Fax

Practice location:
  • Phone: 870-824-6686
  • Fax:
Mailing address:
  • Phone: 870-740-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203404
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: