Healthcare Provider Details

I. General information

NPI: 1528780442
Provider Name (Legal Business Name): MICA FREPPON B.S. SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGH SCHOOL DR
MAGNOLIA AR
71753-2203
US

IV. Provider business mailing address

100 CHERRYWOOD
MAGNOLIA AR
71753-8447
US

V. Phone/Fax

Practice location:
  • Phone: 870-234-7651
  • Fax:
Mailing address:
  • Phone: 501-388-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number202025
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: