Provider Demographics
NPI:1659597011
Name:BOOTH, NILA R (MSP)
Entity Type:Individual
Prefix:MRS
First Name:NILA
Middle Name:R
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 MARION COUNTY 7020
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-8383
Mailing Address - Country:US
Mailing Address - Phone:870-453-3404
Mailing Address - Fax:
Practice Address - Street 1:137 MARION COUNTY 7020
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-8383
Practice Address - Country:US
Practice Address - Phone:870-453-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist