Provider Demographics
NPI:1811147879
Name:COLSON, LEONA M (CCC)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:M
Last Name:COLSON
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600 TRAIN STATION DR
Mailing Address - Street 2:
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103-1644
Mailing Address - Country:US
Mailing Address - Phone:501-909-1638
Mailing Address - Fax:
Practice Address - Street 1:10600 TRAIN STATION DR
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-1644
Practice Address - Country:US
Practice Address - Phone:501-909-1638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8078235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171411721Medicaid