Healthcare Provider Details

I. General information

NPI: 1245476688
Provider Name (Legal Business Name): MARY-MARTHA SLOAN HENRY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 MELLON ST
LITTLE ROCK AR
72207-6150
US

IV. Provider business mailing address

1412 MELLON ST
LITTLE ROCK AR
72207-6150
US

V. Phone/Fax

Practice location:
  • Phone: 501-837-3337
  • Fax:
Mailing address:
  • Phone: 501-837-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number214
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: