Healthcare Provider Details

I. General information

NPI: 1922876010
Provider Name (Legal Business Name): KRISTEN GREEN WIEWORA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 LLAMA DR
SEARCY AR
72143-4793
US

IV. Provider business mailing address

17 MEADOW LANE DR
SEARCY AR
72143-3212
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-5001
  • Fax:
Mailing address:
  • Phone: 901-486-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number202513
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: