Healthcare Provider Details

I. General information

NPI: 1497907653
Provider Name (Legal Business Name): ELIZABETH ADELE LEDBETTER MSSLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 W HUDSON RD
ROGERS AR
72756-2072
US

IV. Provider business mailing address

2510 W HUDSON RD
ROGERS AR
72756-2072
US

V. Phone/Fax

Practice location:
  • Phone: 479-936-1061
  • Fax: 855-812-1132
Mailing address:
  • Phone: 479-936-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#P8156
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: