Provider Demographics
NPI:1790298248
Name:LITTLE ROCK AUDIOLOGY CLINIC, INC.
Entity Type:Organization
Organization Name:LITTLE ROCK AUDIOLOGY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VAN ES
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:501-664-5511
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5306
Mailing Address - Country:US
Mailing Address - Phone:501-664-5511
Mailing Address - Fax:501-664-5149
Practice Address - Street 1:500 S UNIVERSITY AVE STE 405
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5306
Practice Address - Country:US
Practice Address - Phone:501-664-5511
Practice Address - Fax:501-664-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA270231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty