Healthcare Provider Details

I. General information

NPI: 1982977955
Provider Name (Legal Business Name): ALLISON MARIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 WESTERN HILLS AVE
LITTLE ROCK AR
72204-8495
US

IV. Provider business mailing address

41 TUCKER CREEK RD
CONWAY AR
72034-2915
US

V. Phone/Fax

Practice location:
  • Phone: 501-447-6900
  • Fax:
Mailing address:
  • Phone: 501-269-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3783
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: