Healthcare Provider Details

I. General information

NPI: 1811369929
Provider Name (Legal Business Name): ALYSSA STATON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14901 CANTRELL RD
LITTLE ROCK AR
72223-4255
US

IV. Provider business mailing address

14108 HICKORY NUT RIDGE RD
BAUXITE AR
72011-9031
US

V. Phone/Fax

Practice location:
  • Phone: 501-367-1200
  • Fax:
Mailing address:
  • Phone: 501-326-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#3974
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: