Healthcare Provider Details

I. General information

NPI: 1932520558
Provider Name (Legal Business Name): DIANA JOHNSON PEARSON MCD-CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WOODLAND HEIGHTS RD.
LITTLE ROCK AR
72212
US

IV. Provider business mailing address

59 RANCH RIDGE RD.
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-3600
  • Fax:
Mailing address:
  • Phone: 501-868-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#355
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: