Healthcare Provider Details

I. General information

NPI: 1669055836
Provider Name (Legal Business Name): SARAH GRAY MCCARLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10310 W MARKHAM ST STE 205
LITTLE ROCK AR
72205-1579
US

IV. Provider business mailing address

2412 BRIDGEWATER
BRYANT AR
72022-8149
US

V. Phone/Fax

Practice location:
  • Phone: 501-406-7910
  • Fax:
Mailing address:
  • Phone: 501-920-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: