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General NPI Number Information
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NPI Number | 1578841086
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Entity Type | Individual
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Provider Name | ANDREA L TOLIVER-SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 504 E 4TH ST N
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City | PRESCOTT
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State | AR
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Zip | 71857-2254
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Country | US
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Telephone | 870-887-0624
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Fax | 870-887-3185
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Provider Business Mailing Address
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Address Line | PO BOX 537
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City | PRESCOTT
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State | AR
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Zip | 71857-0537
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Country | US
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Telephone | 870-887-0624
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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 | SP#2782
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 06105
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License Number State | MD
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