Provider Demographics
NPI:1396965000
Name:TUBBS, DONNITA BELL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DONNITA
Middle Name:BELL
Last Name:TUBBS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7005
Mailing Address - Country:US
Mailing Address - Phone:870-942-1090
Mailing Address - Fax:
Practice Address - Street 1:430 SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7005
Practice Address - Country:US
Practice Address - Phone:870-942-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1447OtherSTATE LICENSE
AR09134949OtherASHA