Provider Demographics
NPI:1952542276
Name:HUMPHREYS-ROSEBERRY, CLEMMIE KAY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CLEMMIE
Middle Name:KAY
Last Name:HUMPHREYS-ROSEBERRY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:EDGEMONT
Mailing Address - State:AR
Mailing Address - Zip Code:72044-9519
Mailing Address - Country:US
Mailing Address - Phone:870-948-2441
Mailing Address - Fax:
Practice Address - Street 1:265 DAVE CREEK PKY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD BAY
Practice Address - State:AR
Practice Address - Zip Code:72088-9519
Practice Address - Country:US
Practice Address - Phone:501-884-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR320235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist