Provider Demographics
NPI:1669694139
Name:GOBEL, NANCY MARIE
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:GOBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 BUTTERFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-2531
Mailing Address - Country:US
Mailing Address - Phone:479-518-5132
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 57
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:AR
Practice Address - Zip Code:72737-0057
Practice Address - Country:US
Practice Address - Phone:479-521-2366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163281721Medicaid