Provider Demographics
NPI:1770797755
Name:SPEECH LANGUAGE PATHOLOGY SERVICES, INC
Entity type:Organization
Organization Name:SPEECH LANGUAGE PATHOLOGY SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:WOODS
Authorized Official - Last Name:HOLLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC, SLP
Authorized Official - Phone:479-648-1888
Mailing Address - Street 1:2900 OLD GREENWOOD ROAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903
Mailing Address - Country:US
Mailing Address - Phone:479-648-1888
Mailing Address - Fax:479-648-1999
Practice Address - Street 1:2900 OLD GREENWOOD RD
Practice Address - Street 2:SUITE I
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4550
Practice Address - Country:US
Practice Address - Phone:479-648-1888
Practice Address - Fax:479-648-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty