=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134004757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADELINE FAITH ROSE B.S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2025
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1698 N HIGHWAY 7
-----------------------------------------------------
City | HOT SPRINGS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71909-9686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-701-0129
-----------------------------------------------------
Fax | 501-566-1152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 139 OATES TER
-----------------------------------------------------
City | JESSIEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71949-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-701-0129
-----------------------------------------------------
Fax | 501-566-1152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------