Healthcare Provider Details

I. General information

NPI: 1114132883
Provider Name (Legal Business Name): BUILDING BRIDGES THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BLACKFIN DR
RUSSELLVILLE AR
72802-2295
US

IV. Provider business mailing address

820 E HIGHWAY 171
HOT SPRINGS AR
71913-8614
US

V. Phone/Fax

Practice location:
  • Phone: 501-467-0101
  • Fax:
Mailing address:
  • Phone: 501-620-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number06-005
License Number StateAR

VIII. Authorized Official

Name: MISS JENNIFER N. POWELL
Title or Position: SPEECH PATHOLOGY ASSISTANT
Credential: SLPA
Phone: 501-620-8801