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NPI Code Detail

MEDICARE: ANDREA LONG SPEECH THERAPIST

MEDICARE: ANDREA LONG SPEECH THERAPIST
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 PathologistSP1759AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15X364OTHERARBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1225193014
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LONG SPEECH THERAPIST
Provider Business Mailing Address
First Line : 4901 N SHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5293
Country : US
Telephone Number : 501-791-3331
Fax Number : 501-791-0294
Provider Business Practice Location Address
First Line : 4901 N SHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5293
Country : US
Telephone Number : 501-791-3331
Fax Number : 501-791-0294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2006
Last Update Date : 07/08/2007

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Directions to “ ANDREA LONG SPEECH THERAPIST” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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