Healthcare Provider Details

I. General information

NPI: 1235064072
Provider Name (Legal Business Name): MARY MARGARET RAINER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 FOREST PL STE 220
LITTLE ROCK AR
72207-5265
US

IV. Provider business mailing address

5905 FOREST PL STE 220
LITTLE ROCK AR
72207-5265
US

V. Phone/Fax

Practice location:
  • Phone: 501-367-8007
  • Fax:
Mailing address:
  • Phone: 501-367-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203519
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: