Provider Demographics
NPI:1801137237
Name:NOBLE, MYLENA JO (SLP)
Entity type:Individual
Prefix:MRS
First Name:MYLENA
Middle Name:JO
Last Name:NOBLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11071 ROSEBAY LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-8322
Mailing Address - Country:US
Mailing Address - Phone:870-500-3788
Mailing Address - Fax:
Practice Address - Street 1:11071 ROSEBAY LN
Practice Address - Street 2:
Practice Address - City:PRAIRIE GROVE
Practice Address - State:AR
Practice Address - Zip Code:72753-8322
Practice Address - Country:US
Practice Address - Phone:870-500-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2946235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist