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General NPI Number Information
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NPI Number | 1720518277
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Entity Type | Individual
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Provider Name | KATHERINE LEIGH JUSTUS M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 685 SHELBY TRAIL SUITE 1
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City | CONWAY
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State | AR
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Zip | 72034
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Country | US
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Telephone | 501-358-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 109 ZURIE CIRCLE
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City | MAUMELLE
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State | AR
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Zip | 72113
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Country | US
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Telephone | 870-613-5176
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 200138
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License Number State | AR
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