Healthcare Provider Details

I. General information

NPI: 1285363747
Provider Name (Legal Business Name): NAMTIP THEPOUTHAY SAVATHVONGXAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
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

2725 N 50TH ST
FORT SMITH AR
72904-5049
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 479-414-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number201874
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: