Provider Demographics
NPI:1043468960
Name:HOME CENTERED SPEECH SERVICES
Entity Type:Organization
Organization Name:HOME CENTERED SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:EARLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-733-8314
Mailing Address - Street 1:107 HIGHWAY 300
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72126-8213
Mailing Address - Country:US
Mailing Address - Phone:501-733-8314
Mailing Address - Fax:
Practice Address - Street 1:301 ELBERTA STREET
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:AR
Practice Address - Zip Code:72846-8100
Practice Address - Country:US
Practice Address - Phone:501-733-8314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR787235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01089837OtherASHA
AR787OtherARKSHA
AR122644721Medicaid