Healthcare Provider Details

I. General information

NPI: 1922349166
Provider Name (Legal Business Name): ALICEA LOTT SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 201
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

221 RANEY PL
JACKSONVILLE AR
72076-4527
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 501-831-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number13007
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: