Provider Demographics
NPI:1912083395
Name:CORMACK, CAROLINE REBEKAH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:REBEKAH
Last Name:CORMACK
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 1:20 LANTERN HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2934
Mailing Address - Country:US
Mailing Address - Phone:615-415-2010
Mailing Address - Fax:
Practice Address - Street 1:810 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1306
Practice Address - Country:US
Practice Address - Phone:501-447-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist