Provider Demographics
NPI:1326327826
Name:FIDDLER, RAGEN E (MS, CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RAGEN
Middle Name:E
Last Name:FIDDLER
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-5204
Mailing Address - Country:US
Mailing Address - Phone:479-968-1198
Mailing Address - Fax:479-967-1178
Practice Address - Street 1:306 E 11TH ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6156
Practice Address - Country:US
Practice Address - Phone:479-968-1198
Practice Address - Fax:479-967-1178
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist