Healthcare Provider Details

I. General information

NPI: 1790298248
Provider Name (Legal Business Name): LITTLE ROCK AUDIOLOGY CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE STE 405
LITTLE ROCK AR
72205-5306
US

IV. Provider business mailing address

500 S UNIVERSITY AVE STE 405
LITTLE ROCK AR
72205-5306
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-5511
  • Fax: 501-664-5149
Mailing address:
  • Phone: 501-664-5511
  • Fax: 501-664-5149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA270
License Number StateAR

VIII. Authorized Official

Name: DR. TRACY MARIE VAN ES
Title or Position: DOCTOR OF AUDIOLOGY
Credential: AU.D.
Phone: 501-664-5511