Healthcare Provider Details

I. General information

NPI: 1831424720
Provider Name (Legal Business Name): KATIE ELLEN STILWELL BLOODWORTH MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE ELLEN STILWELL MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4408 WALNUT STREET SUITE 7
ROGERS AR
72756-5006
US

IV. Provider business mailing address

103 RIDGEFIELD STREET
BENTONVILLE AR
72712
US

V. Phone/Fax

Practice location:
  • Phone: 479-246-0101
  • Fax: 901-531-6735
Mailing address:
  • Phone: 501-590-6272
  • Fax: 901-531-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP3231
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: