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General NPI Number Information
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NPI Number | 1093298929
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Entity Type | Organization
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Legal Business Name | FAYETTEVILLESPEAKS
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/06/2018
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Provider Practice Location Address
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Address Line | 26 E MEADOW ST STE 4
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5357
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Country | US
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Telephone | 479-466-5976
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Fax |
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Provider Business Mailing Address
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Address Line | 26 E MEADOW ST STE 4
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-5357
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Country | US
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Telephone | 479-466-5976
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Fax |
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Authorized Official
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Title or Position | SLP
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Name | STACY HAYES
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Credential | M.ED.,CCC-SLP
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Telephone | 479-466-5976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1563
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License Number State | AR
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