Provider Demographics
NPI:1922372986
Name:BOARDMAN SPEECH PATHOLOGY, INC.
Entity Type:Organization
Organization Name:BOARDMAN SPEECH PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-462-3528
Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-1339
Mailing Address - Country:US
Mailing Address - Phone:479-462-3528
Mailing Address - Fax:479-754-0384
Practice Address - Street 1:129 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-4212
Practice Address - Country:US
Practice Address - Phone:479-462-3528
Practice Address - Fax:479-754-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1764235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty