Healthcare Provider Details

I. General information

NPI: 1932429941
Provider Name (Legal Business Name): MARY ASHLEY MATHEWS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4767 LISBON RD
SMACKOVER AR
71762-9771
US

IV. Provider business mailing address

4767 LISBON RD
SMACKOVER AR
71762-9771
US

V. Phone/Fax

Practice location:
  • Phone: 870-951-0443
  • Fax:
Mailing address:
  • Phone: 870-951-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3001
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: