Provider Demographics
NPI:1003866476
Name:SHUMPERT, CARMEN (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:
Last Name:SHUMPERT
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 1:11087 ROYAL OAKS RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-8358
Mailing Address - Country:US
Mailing Address - Phone:479-846-5954
Mailing Address - Fax:
Practice Address - Street 1:2474 E JOYCE BLVD
Practice Address - Street 2:STE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4519
Practice Address - Country:US
Practice Address - Phone:479-521-8326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist