Provider Demographics
NPI:1770967689
Name:THE COMMUNICATION STATION
Entity type:Organization
Organization Name:THE COMMUNICATION STATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:870-897-7072
Mailing Address - Street 1:915 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3508
Mailing Address - Country:US
Mailing Address - Phone:870-897-7072
Mailing Address - Fax:870-932-1899
Practice Address - Street 1:915 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3508
Practice Address - Country:US
Practice Address - Phone:870-897-7072
Practice Address - Fax:870-932-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR207202742Medicaid