Healthcare Provider Details

I. General information

NPI: 1831664408
Provider Name (Legal Business Name): DYSTINGUISHED LEARNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 CLOVER LN
CONWAY AR
72032-8997
US

IV. Provider business mailing address

500 AMITY RD, SUITE 5B #139
CONWAY AR
72032
US

V. Phone/Fax

Practice location:
  • Phone: 870-550-7003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RADIAH REYNOLDS
Title or Position: SLP/OWNER
Credential:
Phone: 870-550-7003