Healthcare Provider Details

I. General information

NPI: 1609121375
Provider Name (Legal Business Name): KELLY B. PITTMAN M.S. CFY, SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 KANIS RD.
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

11714 PLEASANT RIDGE DR. #301
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 501-993-7171
  • Fax: 501-223-8075
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: