Individual
NICOLE BAILEY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2740 COLLEGE AVE, CONWAY, AR 72034-6141
(501) 329-5459
Mailing address
2740 COLLEGE AVE, CONWAY, AR 72034-6141
(501) 329-5459
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
201257
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209717721
—
AR
Enumeration date
11/02/2015
Last updated
11/20/2023
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