Healthcare Provider Details

I. General information

NPI: 1942916457
Provider Name (Legal Business Name): KELLY ROSS KROUT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 40TH ST
ROGERS AR
72758-1643
US

IV. Provider business mailing address

2400 S 48TH ST
SPRINGDALE AR
72762-6683
US

V. Phone/Fax

Practice location:
  • Phone: 479-273-9088
  • Fax:
Mailing address:
  • Phone: 479-750-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12113-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: