Healthcare Provider Details

I. General information

NPI: 1245518083
Provider Name (Legal Business Name): ARKANSAS SPEECH PATHOLOGY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2011
Last Update Date: 07/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 GARDENIA LN
HARRISON AR
72601-4505
US

IV. Provider business mailing address

383 GARDENIA LN
HARRISON AR
72601-4505
US

V. Phone/Fax

Practice location:
  • Phone: 870-577-5234
  • Fax:
Mailing address:
  • Phone: 870-577-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License NumberSP#966
License Number StateAR

VIII. Authorized Official

Name: MRS. TAMARA CARRELL GRIGGS
Title or Position: PRESIDENT
Credential:
Phone: 870-577-5234