Healthcare Provider Details

I. General information

NPI: 1255537452
Provider Name (Legal Business Name): YOLANDA MICHELLE RAWLS SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YOLANDA MICHELLE WILLIAMS

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7912 MABELVALE PIKE
LITTLE ROCK AR
72209-3353
US

IV. Provider business mailing address

7912 MABELVALE PIKE
LITTLE ROCK AR
72209-3353
US

V. Phone/Fax

Practice location:
  • Phone: 501-570-0904
  • Fax: 501-570-0904
Mailing address:
  • Phone: 501-570-0904
  • Fax: 501-570-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberR#10-002
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: