Provider Demographics
NPI:1952521841
Name:SAWYER, RITA GAYLE (MSE, CCC, SLP-L)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:GAYLE
Last Name:SAWYER
Suffix:
Gender:F
Credentials:MSE, CCC, SLP-L
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:GAYLE
Other - Last Name:CHASTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSE CCC,SLP-L
Mailing Address - Street 1:1500 WILSON LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:WARD
Mailing Address - State:AR
Mailing Address - Zip Code:72176
Mailing Address - Country:US
Mailing Address - Phone:501-941-5630
Mailing Address - Fax:
Practice Address - Street 1:1500 WILSON LOOP ROAD
Practice Address - Street 2:
Practice Address - City:WARD
Practice Address - State:AR
Practice Address - Zip Code:72176
Practice Address - Country:US
Practice Address - Phone:501-941-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR#644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR#58285OtherBLUE CROSS BLUE SHIELD