Provider Demographics
NPI:1508049750
Name:BOARDMAN, RICHARD KENNETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENNETH
Last Name:BOARDMAN
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-1339
Mailing Address - Country:US
Mailing Address - Phone:479-648-1888
Mailing Address - Fax:479-648-1999
Practice Address - Street 1:129 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4212
Practice Address - Country:US
Practice Address - Phone:479-462-3528
Practice Address - Fax:479-754-0384
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARSP#1764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145522721Medicaid