Individual
HEATHER NEWCOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-5048
Mailing address
500 E 3RD ST, RUSSELLVILLE, AR 72801-5204
(479) 968-5048
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
P4-43179516
AR
Other
Enumeration date
07/29/2016
Last updated
07/29/2016
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