Provider Demographics
NPI:1962850255
Name:ARKANSAS THERAPY OUTREACH
Entity Type:Organization
Organization Name:ARKANSAS THERAPY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:501-831-1555
Mailing Address - Street 1:22461 I 30
Mailing Address - Street 2:SUITE 1100A
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-2364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22461 I 30
Practice Address - Street 2:SUITE 1100A
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-2364
Practice Address - Country:US
Practice Address - Phone:501-481-8930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty