Provider Demographics
NPI:1003464025
Name:HASKINS, LORENN DREW (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LORENN
Middle Name:DREW
Last Name:HASKINS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 JONES RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8015
Mailing Address - Country:US
Mailing Address - Phone:870-557-6652
Mailing Address - Fax:
Practice Address - Street 1:1001 N 14TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3660
Practice Address - Country:US
Practice Address - Phone:870-557-6652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200717235Z00000X
AR201243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR236254721Medicaid
AR930936744Medicaid