Provider Demographics
NPI:1972362291
Name:SCARBOUGH-BROWN, RAVEN (SLP)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:SCARBOUGH-BROWN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 STONE ST STE 140
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4568
Mailing Address - Country:US
Mailing Address - Phone:870-336-0220
Mailing Address - Fax:
Practice Address - Street 1:1218 STONE ST STE 140
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4568
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR316591721Medicaid