Stephanie Anderson, MCD,CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Walnut Ridge, AR

NPI 1285892166 · NPPES record last updated May 28, 2008

Key facts

NPI
1285892166
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
SP#1965 (AR)
Practice address
211 W Hickory St
Walnut Ridge, AR 72476-2648
Phone
(870) 886-3212
Fax
(870) 886-3224
NPI assigned
May 28, 2008
Sex
Female
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
SP#1965ARMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Arkansas Educational Cooperative Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X SP#1965 AR Yes

Addresses

Primary practice location

211 W Hickory St
Walnut Ridge, AR 72476-2648

Mailing address

102 Savannah Cir
Walnut Ridge, AR 72476-8554
Phone (870) 897-1609

Other providers in Walnut Ridge, AR

All providers in Walnut Ridge, AR · Speech-Language Pathologist in Arkansas

Sources for this page

Verify at the official NPI Registry.