Provider Demographics
NPI:1780849844
Name:CAGLE, STEPHANIE LYNN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:CAGLE
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 1:2700 BATEMAN RD
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:AR
Mailing Address - Zip Code:71962-9711
Mailing Address - Country:US
Mailing Address - Phone:479-264-1329
Mailing Address - Fax:870-403-0132
Practice Address - Street 1:2700 BATEMAN RD
Practice Address - Street 2:
Practice Address - City:OKOLONA
Practice Address - State:AR
Practice Address - Zip Code:71962-9711
Practice Address - Country:US
Practice Address - Phone:479-264-1329
Practice Address - Fax:870-403-0132
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168258721Medicaid