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General NPI Number Information
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NPI Number | 1134848278
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Entity Type | Individual
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Provider Name | AMY LYNN KOOMS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 100 GAMBLE RD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-3202
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Country | US
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Telephone | 501-315-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 5208 F ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-3514
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Country | US
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Telephone | 318-801-8703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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