Healthcare Provider Details

I. General information

NPI: 1427512912
Provider Name (Legal Business Name): HEAVEN LEIGH HUFFMASTER MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 05/13/2023
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 LONGVIEW DRIVE
JONESBORO AR
72404-5442
US

IV. Provider business mailing address

2911 LONGVIEW DR
JONESBORO AR
72401-5911
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number200903
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: