Provider Demographics
NPI:1093405227
Name:UTHOFF, AVERY D
Entity Type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:D
Last Name:UTHOFF
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MONETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72447-0640
Mailing Address - Country:US
Mailing Address - Phone:501-827-0446
Mailing Address - Fax:
Practice Address - Street 1:3114 FOX RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9322
Practice Address - Country:US
Practice Address - Phone:870-933-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist