Provider Demographics
NPI:1588856561
Name:WOOTEN, LINDA KATHERINE (SLP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:KATHERINE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COX ST
Mailing Address - Street 2:P.O. BOX 368
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-4611
Mailing Address - Country:US
Mailing Address - Phone:501-776-0691
Mailing Address - Fax:501-776-0692
Practice Address - Street 1:121 COX ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-4611
Practice Address - Country:US
Practice Address - Phone:501-776-0691
Practice Address - Fax:501-776-0692
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8034235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR164928721Medicaid