Provider Demographics
NPI:1083872352
Name:WILLARD, JANE BALL (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:BALL
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LILLIE ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3104
Mailing Address - Country:US
Mailing Address - Phone:501-605-3701
Mailing Address - Fax:501-941-2613
Practice Address - Street 1:602 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2601
Practice Address - Country:US
Practice Address - Phone:501-843-3363
Practice Address - Fax:501-941-2613
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist