Healthcare Provider Details

I. General information

NPI: 1982028668
Provider Name (Legal Business Name): ACHIEVE CENTER FOR THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2014
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 OLD GREENWOOD RD SUITE I
FORT SMITH AR
72903-4550
US

IV. Provider business mailing address

2900 OLD GREENWOOD RD SUITE I
FORT SMITH AR
72903-4550
US

V. Phone/Fax

Practice location:
  • Phone: 479-222-6142
  • Fax: 479-222-6148
Mailing address:
  • Phone: 479-222-6142
  • Fax: 479-222-6148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2240
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE GOSCH
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/MEMBER
Credential: M.S., CCC-SLP
Phone: 479-222-6142