Healthcare Provider Details

I. General information

NPI: 1760518542
Provider Name (Legal Business Name): LEE ANN BROSH M.A, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/30/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNWOOD CIR STE A
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

2 INNWOOD CIR STE A
LITTLE ROCK AR
72211
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#302
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: