Provider Demographics
NPI:1083819023
Name:HARDIN, SHIELA M (MA, CCC-SLP-L)
Entity Type:Individual
Prefix:MS
First Name:SHIELA
Middle Name:M
Last Name:HARDIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:MAUMELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72113-6039
Mailing Address - Country:US
Mailing Address - Phone:501-803-4617
Mailing Address - Fax:
Practice Address - Street 1:14 EMERALD DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6039
Practice Address - Country:US
Practice Address - Phone:501-803-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR115932721Medicaid