Provider Demographics
NPI:1780921874
Name:ROUNDS, MIRANDA RACHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:RACHELLE
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CARRIAGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7532
Mailing Address - Country:US
Mailing Address - Phone:402-215-2189
Mailing Address - Fax:
Practice Address - Street 1:1601 GREENHOUSE RD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72713-9292
Practice Address - Country:US
Practice Address - Phone:479-795-1260
Practice Address - Fax:479-795-1261
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP3429235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201369721Medicaid
AR5DF79OtherBCBS