Provider Demographics
NPI:1760839229
Name:MASON, NATALIE BROOKE (SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:BROOKE
Last Name:MASON
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 1:3939 S GRAND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4284
Mailing Address - Country:US
Mailing Address - Phone:479-319-7223
Mailing Address - Fax:
Practice Address - Street 1:2510 W HUDSON RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-2072
Practice Address - Country:US
Practice Address - Phone:479-936-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003733235Z00000X
AR200677235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist