MEDICARE: MS. CINNAMON ANNE KING 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	2288	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2288	OTHER	AR	SLP LICENSE
2	12110384	OTHER	AR	ASHA

General Provider Information

NPI Number	:	1124127204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CINNAMON ANNE KING CCC-SLP

Provider Business Mailing Address
First Line	:	480 WHITNEY WOODS RD
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-8643
Country	:	US
Telephone Number	:	501-505-8109
Fax Number	:	501-450-2239

Provider Business Practice Location Address
First Line	:	408 N CHURCH ST
Second Line	:
City	:	ATKINS
State	:	AR
Zip	:	72823-4149
Country	:	US
Telephone Number	:	501-329-3804
Fax Number	:	501-329-0718

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	01/22/2026

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