Provider Demographics
NPI:1982050308
Name:BASSETT SPEECH PATHOLOGY LLC
Entity Type:Organization
Organization Name:BASSETT SPEECH PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.S. CCC-SLP
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-790-9580
Mailing Address - Street 1:3515 SWEETGUM LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-6614
Mailing Address - Country:US
Mailing Address - Phone:479-790-9580
Mailing Address - Fax:
Practice Address - Street 1:5305 W VILLAGE PKWY STE 9
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8116
Practice Address - Country:US
Practice Address - Phone:479-401-2077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty