Provider Demographics
NPI:1700176542
Name:TRICE, IDA LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:IDA
Middle Name:LINDA
Last Name:TRICE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 771
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72618
Mailing Address - Country:US
Mailing Address - Phone:870-423-9133
Mailing Address - Fax:
Practice Address - Street 1:122 ROSE
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616
Practice Address - Country:US
Practice Address - Phone:870-423-9133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#316103TS0200X
AR#291,#292171R00000X
AR#317235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No171R00000XOther Service ProvidersInterpreter
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist