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General NPI Number Information
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NPI Number | 1700808680
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Entity Type | Individual
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Provider Name | RUTH JOAN FADELY MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | PLAY STRONG PEDIATRIC THERAPY 3625 W. CHESTNUT ST.
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City | ROGERS
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State | AR
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Zip | 72756
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Country | US
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Telephone | 479-246-0101
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Fax | 479-246-0606
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Provider Business Mailing Address
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Address Line | 610 STEEPRO DR
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City | CENTERTON
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State | AR
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Zip | 72719
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Country | US
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Telephone | 918-314-2610
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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 | SA 6148
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License Number State | FL
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