Provider Demographics
NPI:1861644247
Name:HUMPHREYS, ANITA B (MSP,CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:B
Last Name:HUMPHREYS
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 1:410 GOLDSMITH AVE
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH SPRING
Mailing Address - State:AR
Mailing Address - Zip Code:72554-8045
Mailing Address - Country:US
Mailing Address - Phone:870-625-3096
Mailing Address - Fax:
Practice Address - Street 1:410 GOLDSMITH AVE
Practice Address - Street 2:
Practice Address - City:MAMMOTH SPRING
Practice Address - State:AR
Practice Address - Zip Code:72554-8045
Practice Address - Country:US
Practice Address - Phone:870-625-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist