MEDICARE: MR. DEODIS DEWITT FLEMING 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
1	235Z00000X	Speech-Language Pathologist	255	AR

General Provider Information

NPI Number	:	1881759017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEODIS DEWITT FLEMING CCC-SLP

Provider Business Mailing Address
First Line	:	10 LAMONT DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-2117
Country	:	US
Telephone Number	:	501-569-9991
Fax Number	:	501-562-9405

Provider Business Practice Location Address
First Line	:	10 LAMONT DR
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-2117
Country	:	US
Telephone Number	:	501-569-9991
Fax Number	:	501-562-9405

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/09/2007

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Directions to “ MR. DEODIS DEWITT FLEMING CCC-SLP” Practice Location

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