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General NPI Number Information
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NPI Number | 1437367745
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Entity Type | Organization
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Legal Business Name | EARLE SCHOOL DISTRICT
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1401 3RD ST
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City | EARLE
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State | AR
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Zip | 72331-1353
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Country | US
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Telephone | 870-792-8486
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Fax | 980-792-8897
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Provider Business Mailing Address
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Address Line | 1401 3RD ST P.O. BOX 637
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City | EARLE
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State | AR
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Zip | 72331-1353
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Country | US
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Telephone | 870-792-8486
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Fax | 980-792-8897
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST
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Name | MATTIE IVY
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Credential |
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Telephone | 870-792-8486
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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 822
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License Number State | AR
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