Individual
MARK ELIAS FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CCC-A
Contact information
Practice address
10201 KANIS RD, LITTLE ROCK, AR 72205-6203
(501) 227-3800
(501) 907-9750
Mailing address
10201 KANIS RD, LITTLE ROCK, AR 72205-6203
(501) 227-3800
(501) 907-9750
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
282
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487824900
—
AR
Enumeration date
03/12/2008
Last updated
10/21/2008
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