Basic Information
| Provider Information | |||||||||
| NPI: | 1578170700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWLDS | ||||||||
| FirstName: | KAYLEIGH | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1663 N MERION WAY APT 301 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727046586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2709930330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1149 W NEW HOPE RD | ||||||||
| Address2: | |||||||||
| City: | ROGERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727585837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796366290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2020 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 201266 | AR | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.