Provider Demographics
NPI:1588103303
Name:STILLWELL COMMUNICATION THERAPY, LLC
Entity type:Organization
Organization Name:STILLWELL COMMUNICATION THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CCC-SLP SPEECH-LANG. PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENITA (NITA)
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:870-520-6261
Mailing Address - Street 1:1407 MARKETPLACE DR STE 8&9
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5227
Mailing Address - Country:US
Mailing Address - Phone:870-520-6261
Mailing Address - Fax:870-520-6259
Practice Address - Street 1:1407 MARKETPLACE DR STE 8&9
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5227
Practice Address - Country:US
Practice Address - Phone:870-520-6261
Practice Address - Fax:870-520-6259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty