Provider Demographics
NPI:1437385515
Name:LAYTON, DEREK JAMES
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JAMES
Last Name:LAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 GREYHOUND DR
Mailing Address - Street 2:
Mailing Address - City:MARMADUKE
Mailing Address - State:AR
Mailing Address - Zip Code:72443-9686
Mailing Address - Country:US
Mailing Address - Phone:870-597-2711
Mailing Address - Fax:
Practice Address - Street 1:2020 GREYHOUND DR
Practice Address - Street 2:
Practice Address - City:MARMADUKE
Practice Address - State:AR
Practice Address - Zip Code:72443-9686
Practice Address - Country:US
Practice Address - Phone:870-597-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist