Provider Demographics
NPI:1528216843
Name:WOODS, ALLYSON JO
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:JO
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 PUSH MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORFORK
Mailing Address - State:AR
Mailing Address - Zip Code:72658-8938
Mailing Address - Country:US
Mailing Address - Phone:870-405-9366
Mailing Address - Fax:
Practice Address - Street 1:1310 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2730
Practice Address - Country:US
Practice Address - Phone:870-424-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2699OtherARKANSAS BOARD OF EXAMINERS IN SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY