Provider Demographics
NPI:1801046610
Name:RUDOLPH, DEBORAH A (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:RUDOLPH
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 1:8 CYPRESS CV
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4466
Mailing Address - Country:US
Mailing Address - Phone:501-868-8736
Mailing Address - Fax:
Practice Address - Street 1:5312 W 10TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1852
Practice Address - Country:US
Practice Address - Phone:501-280-9195
Practice Address - Fax:501-663-7261
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP145OtherARKANSAS BOARD OF EXAMINERS SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY