Provider Demographics
NPI:1912187592
Name:ALTOM, REID ALEXANDER (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:REID
Middle Name:ALEXANDER
Last Name:ALTOM
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BURNTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5541
Mailing Address - Country:US
Mailing Address - Phone:501-835-0179
Mailing Address - Fax:501-490-5756
Practice Address - Street 1:708 E DIXON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-4114
Practice Address - Country:US
Practice Address - Phone:501-490-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1638235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist