Provider Demographics
NPI:1235250192
Name:ROPER, TRISHA KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:KAY
Last Name:ROPER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:TRISHA
Other - Middle Name:KAY
Other - Last Name:BOARDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3600 CANTRELL ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202
Mailing Address - Country:US
Mailing Address - Phone:501-526-8018
Mailing Address - Fax:501-526-8050
Practice Address - Street 1:2900 OLD GREENWOOD RD STE I
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4578
Practice Address - Country:US
Practice Address - Phone:479-648-1888
Practice Address - Fax:479-648-1999
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1763235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148351721Medicaid