Provider Demographics
NPI:1225255136
Name:LACOMFORA, JENNIFER JILL (SLP, CCC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JILL
Last Name:LACOMFORA
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JILL
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 GREENWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4427
Mailing Address - Country:US
Mailing Address - Phone:501-625-7800
Mailing Address - Fax:501-325-2727
Practice Address - Street 1:100 GREENWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4427
Practice Address - Country:US
Practice Address - Phone:501-625-7800
Practice Address - Fax:501-325-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#665235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117821721Medicaid