Healthcare Provider Details

I. General information

NPI: 1255782009
Provider Name (Legal Business Name): MRS. SPENCER ARLEIGH WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10259 HIGHWAY 63 N APT 12
BONO AR
72416-8677
US

IV. Provider business mailing address

10259 HIGHWAY 63 N APT 12
BONO AR
72416-8677
US

V. Phone/Fax

Practice location:
  • Phone: 870-819-7833
  • Fax:
Mailing address:
  • Phone: 870-819-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberR#15-028
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: