Provider Demographics
NPI:1992837785
Name:KUYKENDALL, VANESSA (SLP, CCC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KUYKENDALL
Suffix:
Gender:F
Credentials:SLP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 EAST REDCUT ROAD
Mailing Address - Street 2:
Mailing Address - City:FOUKE
Mailing Address - State:AR
Mailing Address - Zip Code:71837-0020
Mailing Address - Country:US
Mailing Address - Phone:870-653-7887
Mailing Address - Fax:870-653-7885
Practice Address - Street 1:370 EAST REDCUT RD.
Practice Address - Street 2:
Practice Address - City:FOUKE
Practice Address - State:AR
Practice Address - Zip Code:71837-0020
Practice Address - Country:US
Practice Address - Phone:870-653-7887
Practice Address - Fax:870-653-7885
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1639235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162691721Medicaid