Healthcare Provider Details

I. General information

NPI: 1538283791
Provider Name (Legal Business Name): LAURA LYNETTE REID SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 COUNTY ROAD 215
CHERRY VALLEY AR
72324
US

IV. Provider business mailing address

807 PINEWOOD CV
WYNNE AR
72396-2462
US

V. Phone/Fax

Practice location:
  • Phone: 870-588-3337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#25
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: