Healthcare Provider Details

I. General information

NPI: 1639641293
Provider Name (Legal Business Name): CLEAR PASSAGE THERAPIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 LINWOOD DR STE 2
PARAGOULD AR
72450-6235
US

IV. Provider business mailing address

1301 N 22ND ST
PARAGOULD AR
72450-2272
US

V. Phone/Fax

Practice location:
  • Phone: 870-565-7201
  • Fax: 870-359-6094
Mailing address:
  • Phone: 870-335-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NIKKI NICOLE WILKES
Title or Position: OFFICE MANAGER
Credential:
Phone: 870-919-1978