Healthcare Provider Details

I. General information

NPI: 1851286678
Provider Name (Legal Business Name): RAVEN LAJOY SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 MARKET PLACE AVE STE 400
BRYANT AR
72022-8077
US

IV. Provider business mailing address

8 PLEASANT CV
LITTLE ROCK AR
72211-1825
US

V. Phone/Fax

Practice location:
  • Phone: 501-943-1681
  • Fax:
Mailing address:
  • Phone: 501-690-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: