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General NPI Number Information
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NPI Number | 1568669844
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Entity Type | Individual
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Provider Name | JERI LOU FARABOUGH SLP
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | BRADLEY STREET
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City | STAR CITY
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State | AR
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Zip | 71667
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Country | US
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Telephone | 870-628-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 HILLCREST RD
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City | DUMAS
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State | AR
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Zip | 71639-9428
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Country | US
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Telephone | 870-263-4079
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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 | 614
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License Number State | AR
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