Healthcare Provider Details

I. General information

NPI: 1215051487
Provider Name (Legal Business Name): AUDRA ESTELLE LOVELADY SPEECH LANGUAGE PATH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 APACHE DR
JONESBORO AR
72401-7432
US

IV. Provider business mailing address

3005 APACHE DR
JONESBORO AR
72401-7432
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0238
  • Fax:
Mailing address:
  • Phone: 870-336-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP2144
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: