=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043753114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEXICON SPEECH LANGUAGE & READING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2016
-----------------------------------------------------
Last Update Date | 11/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98 E SUNBRIDGE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-607-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 98 E SUNBRIDGE DR
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER-SLP
-----------------------------------------------------
Name | MEREDITH HENSON
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 501-607-1988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | SP#3797
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------