Individual
KRISTA FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
2515 ROSA ST, BATESVILLE, AR 72501-7764
(870) 612-8536
Mailing address
2515 ROSA ST, BATESVILLE, AR 72501-7764
(870) 612-8536
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141523721
—
AR
Enumeration date
03/15/2007
Last updated
09/03/2009
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