Healthcare Provider Details

I. General information

NPI: 1609754746
Provider Name (Legal Business Name): MARY ELIZABETH WHITE SLP-A
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 GASTON ST
SPARKMAN AR
71763-8616
US

IV. Provider business mailing address

133 GASTON ST
SPARKMAN AR
71763-8616
US

V. Phone/Fax

Practice location:
  • Phone: 870-678-3204
  • Fax:
Mailing address:
  • Phone: 870-678-3204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number203202
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: