Healthcare Provider Details

I. General information

NPI: 1871735845
Provider Name (Legal Business Name): SUZANNE ROBERSON MCCLENDON M.A, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 KANIS RD
LITTLE ROCK AR
72211-3724
US

IV. Provider business mailing address

7 SUGAR MAPLE CT
LITTLE ROCK AR
72212-2138
US

V. Phone/Fax

Practice location:
  • Phone: 501-993-7171
  • Fax: 501-223-8075
Mailing address:
  • Phone: 501-217-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2300
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: