Healthcare Provider Details

I. General information

NPI: 1326372889
Provider Name (Legal Business Name): LAURA HEUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 STONE ST
JONESBORO AR
72401-5347
US

IV. Provider business mailing address

2409 WHITECLIFF CV
JONESBORO AR
72405-8096
US

V. Phone/Fax

Practice location:
  • Phone: 870-275-6439
  • Fax: 870-275-6438
Mailing address:
  • Phone: 870-219-1300
  • Fax: 870-219-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: