Provider Demographics
NPI:1912198730
Name:ROXANN OWEN SPEECH PATHOLOGY, LLC
Entity Type:Organization
Organization Name:ROXANN OWEN SPEECH PATHOLOGY, LLC
Other - Org Name:LET'S TALK SPEECH PATHOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:WYGAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-343-4225
Mailing Address - Street 1:1007 KINGS MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2520
Mailing Address - Country:US
Mailing Address - Phone:501-343-4225
Mailing Address - Fax:501-228-6071
Practice Address - Street 1:26 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-2323
Practice Address - Country:US
Practice Address - Phone:501-580-6619
Practice Address - Fax:580-228-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1878235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty