Healthcare Provider Details

I. General information

NPI: 1043631807
Provider Name (Legal Business Name): SUSANNE VIGUERIE MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2013
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 KAVANAUGH BLVD APT 7
LITTLE ROCK AR
72207-4240
US

IV. Provider business mailing address

3515 E REDWOOD DR
FAYETTEVILLE AR
72703-6646
US

V. Phone/Fax

Practice location:
  • Phone: 501-282-3691
  • Fax:
Mailing address:
  • Phone: 501-282-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#P8733
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: