Provider Demographics
NPI:1336366764
Name:NORTHWEST ARKANSAS EDUCATIONAL SERVICE COOPERATIVE
Entity Type:Organization
Organization Name:NORTHWEST ARKANSAS EDUCATIONAL SERVICE COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-267-5960
Mailing Address - Street 1:4 N DOUBLE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2522
Mailing Address - Country:US
Mailing Address - Phone:479-267-5960
Mailing Address - Fax:479-267-5965
Practice Address - Street 1:4 N DOUBLE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2522
Practice Address - Country:US
Practice Address - Phone:479-267-5960
Practice Address - Fax:479-267-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty