Basic Information
| Provider Information | |||||||||
| NPI: | 1306904347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARKANSAS AUDIOLOGY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2850 PRINCE ST | ||||||||
| Address2: | SUITE 35 | ||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720343636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013297979 | ||||||||
| FaxNumber: | 5013296915 | ||||||||
| Practice Location | |||||||||
| Address1: | 2850 PRINCE ST | ||||||||
| Address2: | SUITE 35 | ||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720343636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013297979 | ||||||||
| FaxNumber: | 5013296915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 08/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | CHIVERS | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
| AuthorizedOfficialMiddleName: | LAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5013297979 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.