Healthcare Provider Details

I. General information

NPI: 1891952487
Provider Name (Legal Business Name): STACY BETH SAMPLE WRIGHT MCD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19251 GREENFIELD RD
HARRISBURG AR
72432-9398
US

IV. Provider business mailing address

505 SCOTCHPINE DR
JONESBORO AR
72404-9087
US

V. Phone/Fax

Practice location:
  • Phone: 870-578-6118
  • Fax:
Mailing address:
  • Phone: 870-578-6118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1873
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: