Healthcare Provider Details

I. General information

NPI: 1104033059
Provider Name (Legal Business Name): CANDICE REED M.S.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PECAN ST
CROSSETT AR
71635-3530
US

IV. Provider business mailing address

800 PECAN ST
CROSSETT AR
71635-3530
US

V. Phone/Fax

Practice location:
  • Phone: 870-853-2864
  • Fax: 870-853-8264
Mailing address:
  • Phone: 870-853-2864
  • Fax: 870-853-8264

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: