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General NPI Number Information
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NPI Number | 1598951600
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Entity Type | Organization
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Legal Business Name | THE SPEECH SHOP, INC.
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 104 E EVERETT ST
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City | POCAHONTAS
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State | AR
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Zip | 72455
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Country | US
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Telephone | 870-378-6789
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Fax | 870-248-0036
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Provider Business Mailing Address
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Address Line | 452 LAKE DR
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City | POCAHONTAS
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State | AR
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Zip | 72455-1439
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Country | US
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Telephone | 870-378-6789
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Fax | 870-248-0036
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST/OWNER
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Name | MRS. MARILYN KAY HOGAN
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Credential | CCC-SLP
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Telephone | 870-378-6789
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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 | 532
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License Number State | AR
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