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General NPI Number Information
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NPI Number | 1194971507
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Entity Type | Organization
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Legal Business Name | KIMBERLY B WALLACE
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 7000 VALLEY DR
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City | LITTLE ROCK
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State | AR
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Zip | 72209-7522
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Country | US
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Telephone | 501-447-6844
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Fax |
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Provider Business Mailing Address
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Address Line | 901 SHAMROCK DR
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City | LITTLE ROCK
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State | AR
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Zip | 72207-6027
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Country | US
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Telephone | 501-416-4711
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MRS. KIMBERLY B. WALLACE
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Credential | M.S., CCC-SLP
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Telephone | 501-447-6844
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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 | AR#521
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License Number State | AR
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