MEDICARE: MITCHELL DAVID BARKER CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP#P8918	AR

General Provider Information

NPI Number	:	1003275454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL DAVID BARKER CCC-SLP

Provider Business Mailing Address
First Line	:	2703 W GUM ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-4849
Country	:	US
Telephone Number	:	616-255-6609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 NE MCCLAIN RD
Second Line	:
City	:	BENTONVILLE
State	:	AR
Zip	:	72712-3875
Country	:	US
Telephone Number	:	616-255-6609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2016
Last Update Date	:	05/11/2016

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Directions to “ MITCHELL DAVID BARKER CCC-SLP” Practice Location

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