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General NPI Number Information
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NPI Number | 1316159197
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Entity Type | Individual
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Provider Name | CARRIE ANN ADELE WILLYARD M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 2 AKERMAN LN
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City | BELLA VISTA
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State | AR
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Zip | 72714-5228
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Country | US
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Telephone | 479-270-3720
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Fax | 479-696-7779
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Provider Business Mailing Address
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Address Line | 2 ABBAS CIR
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City | BELLA VISTA
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State | AR
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Zip | 72714-4200
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Country | US
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Telephone | 479-426-9182
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Fax | 479-696-8667
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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#P8012
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License Number State | AR
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