Provider Demographics
NPI:1477624039
Name:CALDWELL, CALLIE R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:R
Last Name:CALDWELL
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:PO BOX 980
Mailing Address - Street 2:
Mailing Address - City:LONOKE
Mailing Address - State:AR
Mailing Address - Zip Code:72086-0980
Mailing Address - Country:US
Mailing Address - Phone:501-676-2786
Mailing Address - Fax:501-676-0697
Practice Address - Street 1:518 E FRONT ST
Practice Address - Street 2:
Practice Address - City:LONOKE
Practice Address - State:AR
Practice Address - Zip Code:72086-3262
Practice Address - Country:US
Practice Address - Phone:501-676-2786
Practice Address - Fax:501-676-0697
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1687235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist