Provider Demographics
NPI:1942385877
Name:COLVIN, JO ELLEN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JO ELLEN
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
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:PO BOX 10251
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-0001
Mailing Address - Country:US
Mailing Address - Phone:870-862-0500
Mailing Address - Fax:870-862-2100
Practice Address - Street 1:214 HOPE LANDING
Practice Address - Street 2:HWY. 82 EAST
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-862-0500
Practice Address - Fax:870-862-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1989235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist