Provider Demographics
NPI:1316199151
Name:HEGEFELD, CARISA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARISA
Middle Name:
Last Name:HEGEFELD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MCCLURE AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9715
Mailing Address - Country:US
Mailing Address - Phone:479-631-3610
Mailing Address - Fax:
Practice Address - Street 1:202 MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9715
Practice Address - Country:US
Practice Address - Phone:479-631-3610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist