Healthcare Provider Details

I. General information

NPI: 1699516336
Provider Name (Legal Business Name): CHRISTENA LYNN GEORGE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 GOBLIN DR
HARRISON AR
72601-8885
US

IV. Provider business mailing address

1966 COUNTY ROAD 719
BERRYVILLE AR
72616-4584
US

V. Phone/Fax

Practice location:
  • Phone: 870-654-3869
  • Fax: 870-505-2016
Mailing address:
  • Phone: 870-350-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203608
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: