Provider Demographics
NPI:1003190562
Name:BINGHAM, MARCIA ROLES (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:ROLES
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LAGRUE DR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5835
Mailing Address - Country:US
Mailing Address - Phone:501-993-3564
Mailing Address - Fax:501-223-8075
Practice Address - Street 1:11517 KANIS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3724
Practice Address - Country:US
Practice Address - Phone:501-993-8707
Practice Address - Fax:501-223-8075
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1309235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist