Healthcare Provider Details

I. General information

NPI: 1932696507
Provider Name (Legal Business Name): WHITE RIVER HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/02/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 CIFUENTES WAY
HOT SPRINGS VILLAGE AR
71909-7440
US

IV. Provider business mailing address

63 CIFUENTES WAY
HOT SPRINGS VILLAGE AR
71909-7440
US

V. Phone/Fax

Practice location:
  • Phone: 214-549-8651
  • Fax:
Mailing address:
  • Phone: 214-549-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE SMITH
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 214-549-8651