Provider Demographics
NPI:1437367745
Name:EARLE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:EARLE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-792-8486
Mailing Address - Street 1:1401 3RD ST
Mailing Address - Street 2:P.O. BOX 637
Mailing Address - City:EARLE
Mailing Address - State:AR
Mailing Address - Zip Code:72331-1353
Mailing Address - Country:US
Mailing Address - Phone:870-792-8486
Mailing Address - Fax:980-792-8897
Practice Address - Street 1:1401 3RD ST
Practice Address - Street 2:
Practice Address - City:EARLE
Practice Address - State:AR
Practice Address - Zip Code:72331-1353
Practice Address - Country:US
Practice Address - Phone:870-792-8486
Practice Address - Fax:980-792-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP 822235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR183723743Medicaid