Healthcare Provider Details

I. General information

NPI: 1043468960
Provider Name (Legal Business Name): HOME CENTERED SPEECH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ELBERTA STREET
LAMAR AR
72846-8100
US

IV. Provider business mailing address

107 HIGHWAY 300
PERRYVILLE AR
72126-8213
US

V. Phone/Fax

Practice location:
  • Phone: 501-733-8314
  • Fax:
Mailing address:
  • Phone: 501-733-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number787
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number787
License Number StateAR

VIII. Authorized Official

Name: BEVERLY J EARLS
Title or Position: SLP
Credential:
Phone: 501-733-8314