MEDICARE: ELIZABETH CHILEY BARTLETT

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	1106	AR

General Provider Information

NPI Number	:	1336351287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CHILEY BARTLETT

Provider Business Mailing Address
First Line	:	7102 HIGHWAY 1 S
Second Line	:
City	:	MARVELL
State	:	AR
Zip	:	72366-9107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 W HIGHWAY 49
Second Line	:
City	:	WEST HELENA
State	:	AR
Zip	:	72390-1716
Country	:	US
Telephone Number	:	870-572-3417
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/09/2007

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