Healthcare Provider Details

I. General information

NPI: 1992837785
Provider Name (Legal Business Name): VANESSA KUYKENDALL SLP, CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 EAST REDCUT RD.
FOUKE AR
71837-0020
US

IV. Provider business mailing address

370 EAST REDCUT ROAD
FOUKE AR
71837-0020
US

V. Phone/Fax

Practice location:
  • Phone: 870-653-7887
  • Fax: 870-653-7885
Mailing address:
  • Phone: 870-653-7887
  • Fax: 870-653-7885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1639
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: