Healthcare Provider Details

I. General information

NPI: 1548025711
Provider Name (Legal Business Name): APPLE FLATS SPEECH PATHOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2206 N JACKSON
MAGNOLIA AR
71753-2065
US

IV. Provider business mailing address

502 E 12TH ST
SMACKOVER AR
71762-2123
US

V. Phone/Fax

Practice location:
  • Phone: 870-510-2841
  • Fax:
Mailing address:
  • Phone: 870-665-9526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BONNIE VEST
Title or Position: SLP
Credential:
Phone: 870-510-2841