Basic Information
| Provider Information | |||||||||
| NPI: | 1740599935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED SPEECH THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10014 N RODNEY PARHAM RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722275548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019603400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10014 N RODNEY PARHAM RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722275548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019603400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2010 | ||||||||
| LastUpdateDate: | 10/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | TOWNLEY | ||||||||
| AuthorizedOfficialFirstName: | AMIE | ||||||||
| AuthorizedOfficialMiddleName: | REBECCA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5019603400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | SLP, CCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2622 | AR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.