MEDICARE: MRS. SARAH ELIZABETH CALLICOTT M.S, CFY-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	906250491	AR

General Provider Information

NPI Number	:	1417108499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH ELIZABETH CALLICOTT M.S, CFY-SLP

Provider Business Mailing Address
First Line	:	7353 RIVER POINTE DR
Second Line	:	APT. 21
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-6957
Country	:	US
Telephone Number	:	501-542-4440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 CRUTCHER ST
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-3953
Country	:	US
Telephone Number	:	501-340-5160
Fax Number	:

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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