Provider Demographics
NPI:1063672996
Name:RUNYAN, CONNIE
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:RUNYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11636 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-7473
Mailing Address - Country:US
Mailing Address - Phone:501-865-4506
Mailing Address - Fax:501-865-4545
Practice Address - Street 1:11636 HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-7473
Practice Address - Country:US
Practice Address - Phone:501-865-4506
Practice Address - Fax:501-865-4545
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist