Individual
CASEY RENAE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 S. SPRING ST., LITTLE ROCK, AR 72206
(205) 942-6820
Mailing address
165 HIGHLAND PARK, CONWAY, AR 72034
(850) 443-8577
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12083868ASHA
—
235Z00000X
Speech-Language Pathologist
2753
AL
Other
Enumeration date
02/23/2010
Last updated
10/10/2018
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