Provider Demographics
NPI:1063682599
Name:HUTSON, GROVER HENRY (AUD)
Entity Type:Individual
Prefix:DR
First Name:GROVER
Middle Name:HENRY
Last Name:HUTSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 FAIRWAY AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-8066
Mailing Address - Country:US
Mailing Address - Phone:501-753-8444
Mailing Address - Fax:501-753-9170
Practice Address - Street 1:4701 FAIRWAY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-8066
Practice Address - Country:US
Practice Address - Phone:501-753-8444
Practice Address - Fax:501-753-9170
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR53231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1063682599Medicaid
AR1063682599Medicaid