Provider Demographics
NPI:1043651532
Name:ARKANSAS SPECIAL SERVICES
Entity Type:Organization
Organization Name:ARKANSAS SPECIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:501-786-9181
Mailing Address - Street 1:5710 WARDEN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6064
Mailing Address - Country:US
Mailing Address - Phone:501-392-6102
Mailing Address - Fax:
Practice Address - Street 1:5710 WARDEN RD STE 5
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6064
Practice Address - Country:US
Practice Address - Phone:501-392-6102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2729235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR197547742Medicaid