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NPI Code Detail

MEDICARE: MRS. STACY ANN KINDERVATER M.S., CCC-SLP

MEDICARE: MRS. STACY ANN KINDERVATER M.S., 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
1235Z00000XSpeech-Language PathologistSP1123AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164683504
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STACY ANN KINDERVATER M.S., CCC-SLP
Provider Business Mailing Address
First Line : 810 W MARKHAM ST
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72201-1306
Country : US
Telephone Number : 501-447-1000
Fax Number : 501-447-4801
Provider Business Practice Location Address
First Line : 1200 RESERVOIR RD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72227-5712
Country : US
Telephone Number : 501-447-5529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2008
Last Update Date : 02/21/2024

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Directions to “ MRS. STACY ANN KINDERVATER M.S., CCC-SLP” Practice Location

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