Provider Demographics
NPI:1649253006
Name:STEPHENS SPEECH CLINIC PA
Entity type:Organization
Organization Name:STEPHENS SPEECH CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUPHAMA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCS SLP
Authorized Official - Phone:870-741-0500
Mailing Address - Street 1:PLAZA 43 200 HIGHWAY 43 EAST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601
Mailing Address - Country:US
Mailing Address - Phone:870-741-0500
Mailing Address - Fax:870-741-6196
Practice Address - Street 1:PLAZA 43 200 HIGHWAY 43 EAST
Practice Address - Street 2:SUITE 7
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601
Practice Address - Country:US
Practice Address - Phone:870-741-0500
Practice Address - Fax:870-741-6196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARST155OtherBCBS
AR5U196OtherBCBS