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General NPI Number Information
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NPI Number | 1922372986
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Entity Type | Organization
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Legal Business Name | BOARDMAN SPEECH PATHOLOGY, INC.
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 129 E POPLAR ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-4212
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Country | US
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Telephone | 479-462-3528
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Fax | 479-754-0384
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Provider Business Mailing Address
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Address Line | PO BOX 1339
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City | CLARKSVILLE
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State | AR
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Zip | 72830-1339
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Country | US
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Telephone | 479-462-3528
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Fax | 479-754-0384
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | RICHARD K BOARDMAN
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Credential |
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Telephone | 479-462-3528
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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 | 1764
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License Number State | AR
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