Healthcare Provider Details

I. General information

NPI: 1700808680
Provider Name (Legal Business Name): RUTH JOAN FADELY MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAY STRONG PEDIATRIC THERAPY 3625 W. CHESTNUT ST.
ROGERS AR
72756
US

IV. Provider business mailing address

610 STEEPRO DR
CENTERTON AR
72719
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax: 479-246-0606
Mailing address:
  • Phone: 918-314-2610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 6148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: