Provider Demographics
NPI:1619548351
Name:HARTMAN, KAYLEE (SLP)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:HARTMAN
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 1:3127 SOUTHWEST DR STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8404
Mailing Address - Country:US
Mailing Address - Phone:870-336-8100
Mailing Address - Fax:
Practice Address - Street 1:1268 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7498
Practice Address - Country:US
Practice Address - Phone:479-750-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP201032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist