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General NPI Number Information
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NPI Number | 1790298248
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Entity Type | Organization
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Legal Business Name | LITTLE ROCK AUDIOLOGY CLINIC, INC.
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 500 S UNIVERSITY AVE STE 405
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5306
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Country | US
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Telephone | 501-664-5511
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Fax | 501-664-5149
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Provider Business Mailing Address
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Address Line | 500 S UNIVERSITY AVE STE 405
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5306
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Country | US
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Telephone | 501-664-5511
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Fax | 501-664-5149
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Authorized Official
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Title or Position | DOCTOR OF AUDIOLOGY
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Name | DR. TRACY MARIE VAN ES
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Credential | AU.D.
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Telephone | 501-664-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A270
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License Number State | AR
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