Individual
MRS. DONNA MANSUETO EDGMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2700 AMERICAN ST, SPRINGDALE, AR 72764-6937
(479) 751-5504
(479) 751-6446
Mailing address
4197 TARA ST, SPRINGDALE, AR 72762-7944
(479) 751-6243
(479) 751-6446
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
235
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56124
BLUE CROSS BLUE SHEILD
AR
Enumeration date
04/26/2006
Last updated
07/09/2007
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