Provider Demographics
NPI:1487867040
Name:GEELS, FAWN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:
Last Name:GEELS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CORNERSTONE
Other - Middle Name:
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:295 SOUTHWICK CV
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5514
Mailing Address - Country:US
Mailing Address - Phone:501-472-0599
Mailing Address - Fax:
Practice Address - Street 1:295 SOUTHWICK CV
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5514
Practice Address - Country:US
Practice Address - Phone:501-472-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2286235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR159249721Medicaid