Healthcare Provider Details

I. General information

NPI: 1437724630
Provider Name (Legal Business Name): MADDISON GRACE MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 9TH ST
DE QUEEN AR
71832-2700
US

IV. Provider business mailing address

137 LOCKESBURG TIMBER RD
LOCKESBURG AR
71846-9666
US

V. Phone/Fax

Practice location:
  • Phone: 870-584-4312
  • Fax:
Mailing address:
  • Phone: 870-200-2776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: