Healthcare Provider Details

I. General information

NPI: 1063022986
Provider Name (Legal Business Name): ADULT SPEECH AND VOICE CARE OF NORTHWEST ARKANSAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 N CORSICA DR
FAYETTEVILLE AR
72704-6168
US

IV. Provider business mailing address

1516 N CORSICA DR
FAYETTEVILLE AR
72704-6168
US

V. Phone/Fax

Practice location:
  • Phone: 479-358-7819
  • Fax:
Mailing address:
  • Phone: 479-358-7819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TORRY LYNN FARNELL
Title or Position: SPEECH-LANGUAGE PATHOLOGIST, OWNER
Credential: M.S., CCC-SLP
Phone: 479-358-7819