MEDICARE: JOSIE RAE FAIRCHILD 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	203421	AR

General Provider Information

NPI Number	:	1174480412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSIE RAE FAIRCHILD SLP

Provider Business Mailing Address
First Line	:	1015 CEDAR GROVE RD
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9525
Country	:	US
Telephone Number	:	870-793-6831
Fax Number	:	870-793-6760

Provider Business Practice Location Address
First Line	:	480 N MAIN ST
Second Line	:
City	:	SULPHUR ROCK
State	:	AR
Zip	:	72579-9504
Country	:	US
Telephone Number	:	870-799-3149
Fax Number	:

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ JOSIE RAE FAIRCHILD SLP” Practice Location

Language	Start Address	Practice Location

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