Provider Demographics
NPI:1700808680
Name:FADELY, RUTH JOAN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:JOAN
Last Name:FADELY
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 1:610 STEEPRO DR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719
Mailing Address - Country:US
Mailing Address - Phone:918-314-2610
Mailing Address - Fax:
Practice Address - Street 1:PLAY STRONG PEDIATRIC THERAPY
Practice Address - Street 2:3625 W. CHESTNUT ST.
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756
Practice Address - Country:US
Practice Address - Phone:479-246-0101
Practice Address - Fax:479-246-0606
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR230774721Medicaid
FL887786600Medicaid