=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336962851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUNCTION FIRST LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 CASHIN LN
-----------------------------------------------------
City | BELLA VISTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72715-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-936-6184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 CASHIN LN
-----------------------------------------------------
City | BELLA VISTA
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72715-4957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-936-6184
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, SLP
-----------------------------------------------------
Name | MRS. MADILYN LITTLEFIELD METCALF
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 479-936-6184
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------