Provider Demographics
NPI:1831424720
Name:STILWELL BLOODWORTH, KATIE ELLEN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELLEN
Last Name:STILWELL BLOODWORTH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:ELLEN
Other - Last Name:STILWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:103 RIDGEFIELD STREET
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712
Mailing Address - Country:US
Mailing Address - Phone:501-590-6272
Mailing Address - Fax:901-531-6735
Practice Address - Street 1:4408 WALNUT STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-5006
Practice Address - Country:US
Practice Address - Phone:479-246-0101
Practice Address - Fax:901-531-6735
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP3231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist