Provider Demographics
NPI:1447416664
Name:RYBURN, CHARLOTTE (MSP, CCC-SLP, L-SP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:RYBURN
Suffix:
Gender:F
Credentials:MSP, CCC-SLP, L-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 110
Mailing Address - Street 2:
Mailing Address - City:GILLHAM
Mailing Address - State:AR
Mailing Address - Zip Code:71841
Mailing Address - Country:US
Mailing Address - Phone:870-386-2251
Mailing Address - Fax:870-386-7731
Practice Address - Street 1:305 S HORNBERG AVE
Practice Address - Street 2:
Practice Address - City:GILLHAM
Practice Address - State:AR
Practice Address - Zip Code:71841
Practice Address - Country:US
Practice Address - Phone:870-386-2251
Practice Address - Fax:870-386-7731
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP-181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist