Healthcare Provider Details

I. General information

NPI: 1982752002
Provider Name (Legal Business Name): KIMBERLY CAROLINE SCARSDALE CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR
SPRINGDALE AR
72762-6362
US

IV. Provider business mailing address

10 BLIZZEN LN
BELLA VISTA AR
72714-3236
US

V. Phone/Fax

Practice location:
  • Phone: 479-295-0316
  • Fax:
Mailing address:
  • Phone: 479-295-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberSP2769
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5683
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: