Provider Demographics
NPI:1972726578
Name:UNIVERSITY OF ARKANSAS
Entity Type:Organization
Organization Name:UNIVERSITY OF ARKANSAS
Other - Org Name:UNIVERSITY OF ARKANSAS SPEECH AND HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALETHA
Authorized Official - Middle Name:LIN
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:479-575-4509
Mailing Address - Street 1:606 N RAZORBACK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-3110
Mailing Address - Country:US
Mailing Address - Phone:479-575-4509
Mailing Address - Fax:479-575-4507
Practice Address - Street 1:606 N RAZORBACK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3110
Practice Address - Country:US
Practice Address - Phone:479-575-4509
Practice Address - Fax:479-575-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR198009742Medicaid