Healthcare Provider Details

I. General information

NPI: 1891001483
Provider Name (Legal Business Name): KELLY A POUND MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 WOODLAND CREEK CIR
VAN BUREN AR
72956-2274
US

IV. Provider business mailing address

5226 S 62ND ST
ROGERS AR
72758-8141
US

V. Phone/Fax

Practice location:
  • Phone: 479-381-7818
  • Fax:
Mailing address:
  • Phone: 479-381-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2125
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: