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General NPI Number Information
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NPI Number | 1154697928
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Entity Type | Individual
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Provider Name | FORREST DAYANNE UTLEY MCD, CCC -SLP
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 390 COUNTY ROAD 372
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City | WYNNE
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State | AR
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Zip | 72396-8552
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Country | US
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Telephone | 870-238-6550
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Fax |
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Provider Business Mailing Address
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Address Line | 390 COUNTY ROAD 372
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City | WYNNE
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State | AR
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Zip | 72396-8552
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Country | US
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Telephone | 870-238-6550
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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 | SP#861
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License Number State | AR
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