Organization
KIMBERLY B WALLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY B. WALLACE M.S., CCC-SLP (SPEECH PATHOLOGIST)
(501) 447-6844
Entity
Organization
Contact information
Practice address
7000 VALLEY DR, LITTLE ROCK, AR 72209-7522
(501) 447-6844
Mailing address
901 SHAMROCK DR, LITTLE ROCK, AR 72207-6027
(501) 416-4711
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
AR#521
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP#521
ARKANSAS BOARD OF EXAMINERS IN SPEECH PATHOLOGY & AUDIOLOGY LICENSE
AR
Enumeration date
08/18/2008
Last updated
10/15/2008
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