Healthcare Provider Details

I. General information

NPI: 1205184991
Provider Name (Legal Business Name): MICHELLE HERNANDEZ M.S. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10920 HEBER SPRINGS RD N
CONCORD AR
72523-9412
US

IV. Provider business mailing address

PO BOX 10
CONCORD AR
72523-0010
US

V. Phone/Fax

Practice location:
  • Phone: 501-206-1583
  • Fax:
Mailing address:
  • Phone: 501-206-1583
  • 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: