Healthcare Provider Details

I. General information

NPI: 1013225044
Provider Name (Legal Business Name): JETTA CHERE PERRY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E HARDING ST
MORRILTON AR
72110-2047
US

IV. Provider business mailing address

5740 GRAND TETON LN
CONWAY AR
72034-7623
US

V. Phone/Fax

Practice location:
  • Phone: 501-697-9881
  • Fax:
Mailing address:
  • Phone: 501-840-2395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4203
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: