Provider Demographics
NPI:1760648281
Name:KING, SCARLET LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SCARLET
Middle Name:LEIGH
Last Name:KING
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:AR
Mailing Address - Zip Code:72645-8885
Mailing Address - Country:US
Mailing Address - Phone:870-447-3044
Mailing Address - Fax:
Practice Address - Street 1:800 ELM ST
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:AR
Practice Address - Zip Code:72645-8865
Practice Address - Country:US
Practice Address - Phone:870-447-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#988235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR12757721Medicaid