Individual
MARIETTA WOOLLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1240 QUAILRIDGE WAY, BENTONVILLE, AR 72713-3091
(870) 314-3042
Mailing address
1240 QUAILRIDGE WAY, BENTONVILLE, AR 72713-3091
(870) 314-3042
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2058
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152371721
—
AR
Enumeration date
03/08/2007
Last updated
11/07/2024
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