Provider Demographics
NPI:1164731253
Name:THE SPEECH PATH OF NEA, LLC
Entity Type:Organization
Organization Name:THE SPEECH PATH OF NEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BOECKMANN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:870-588-1997
Mailing Address - Street 1:25 WYNNEWOOD DR N
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-1803
Mailing Address - Country:US
Mailing Address - Phone:870-588-1997
Mailing Address - Fax:870-208-8139
Practice Address - Street 1:615 CANAL AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3003
Practice Address - Country:US
Practice Address - Phone:870-588-1997
Practice Address - Fax:870-208-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty