Provider Demographics
NPI:1932761392
Name:ATCHLEY-BABB, MARYANNE ALISA (SLP)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:ALISA
Last Name:ATCHLEY-BABB
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MARYANNE
Other - Middle Name:ALISA
Other - Last Name:ATCHLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 EAMES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-7108
Mailing Address - Country:US
Mailing Address - Phone:479-640-2218
Mailing Address - Fax:
Practice Address - Street 1:201 S GILES AVE
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-9320
Practice Address - Country:US
Practice Address - Phone:479-736-8562
Practice Address - Fax:479-736-5682
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist