Provider Demographics
NPI:1932227550
Name:SEARK'S HEART INC
Entity Type:Organization
Organization Name:SEARK'S HEART INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUBB
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:870-866-2940
Mailing Address - Street 1:PO BOX 3055
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71656-3055
Mailing Address - Country:US
Mailing Address - Phone:870-367-6694
Mailing Address - Fax:870-367-6694
Practice Address - Street 1:1200 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655
Practice Address - Country:US
Practice Address - Phone:870-367-6694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U478Medicare UPIN