Healthcare Provider Details

I. General information

NPI: 1285875294
Provider Name (Legal Business Name): PAULA TEAGUE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6275 HEBER SPRINGS RD W
QUITMAN AR
72131-9294
US

IV. Provider business mailing address

6275 HEBER SPRINGS RD W
QUITMAN AR
72131-9294
US

V. Phone/Fax

Practice location:
  • Phone: 501-589-2807
  • Fax:
Mailing address:
  • Phone: 501-589-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#1311
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: