Provider Demographics
NPI:1083963102
Name:MICHA MORGAN LAMBERSON, INC
Entity Type:Organization
Organization Name:MICHA MORGAN LAMBERSON, INC
Other - Org Name:KIDABILITIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHA
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:LAMBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-598-4477
Mailing Address - Street 1:4600 LOCHMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-8152
Mailing Address - Country:US
Mailing Address - Phone:870-598-4477
Mailing Address - Fax:870-275-6439
Practice Address - Street 1:2729 E NETTLETON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4530
Practice Address - Country:US
Practice Address - Phone:870-598-4477
Practice Address - Fax:870-275-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR#12-0142355S0801X
AR2355508012355S0801X
ARSP#2411235Z00000X
ARSP#1608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193112742Medicaid