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General NPI Number Information
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NPI Number | 1942170717
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Entity Type | Individual
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Provider Name | LINZI WALLIS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 415 N 6TH ST
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City | NASHVILLE
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State | AR
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Zip | 71852-4404
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Country | US
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Telephone | 870-845-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 395 HORNBERG AVENUE
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City | GILLHAM
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State | AR
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Zip | 71841
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Country | US
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Telephone | 479-385-4319
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 203358
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License Number State | AR
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