Individual
KATELYN ELIZABETH DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10668 LYDIA LN, DANVILLE, AR 72833-6890
(479) 393-1138
Mailing address
17799 N HIGHWAY 27, BELLEVILLE, AR 72824-9124
(479) 622-0226
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200685
—
AR
Enumeration date
07/14/2019
Last updated
07/14/2019
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