Individual
AMANDA BROADSTREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1000 W POPLAR ST, ROGERS, AR 72756-4242
(479) 631-7678
Mailing address
1000 W POPLAR ST, ROGERS, AR 72756-4242
(479) 631-7678
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1061
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162451721
—
AR
Enumeration date
03/30/2007
Last updated
09/27/2024
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