Healthcare Provider Details

I. General information

NPI: 1699692657
Provider Name (Legal Business Name): TIA TEAGUE THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N OAK ST
HACKETT AR
72937-4756
US

IV. Provider business mailing address

3710 OLD OAKS LN
FORT SMITH AR
72903-3336
US

V. Phone/Fax

Practice location:
  • Phone: 479-638-8606
  • Fax:
Mailing address:
  • Phone: 479-208-2288
  • Fax:

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: TIA TEAGUE
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: MS CCC-SLP
Phone: 479-208-2288