Provider Demographics
NPI:1760699987
Name:NELSON, JANET L (MSP, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-2209
Mailing Address - Country:US
Mailing Address - Phone:870-355-8609
Mailing Address - Fax:
Practice Address - Street 1:408 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:AR
Practice Address - Zip Code:71640-2209
Practice Address - Country:US
Practice Address - Phone:870-355-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR418235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123938721Medicaid