Provider Demographics
NPI:1952654287
Name:WADDELL, RHONDA SUZANNE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUZANNE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 RED WOLF BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5453
Mailing Address - Country:US
Mailing Address - Phone:870-926-2692
Mailing Address - Fax:
Practice Address - Street 1:1699 RED WOLF BLVD STE H
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5453
Practice Address - Country:US
Practice Address - Phone:870-926-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
ARSP#8539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist