Individual
MS. MATTIE IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
724 PARK ST, FORREST CITY, AR 72335-4823
(870) 633-4366
(870) 792-7371
Mailing address
724 PARK ST, FORREST CITY, AR 72335-4823
(870) 633-4366
(870) 792-7371
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP 822
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127746721
—
AR
Enumeration date
05/18/2007
Last updated
07/08/2007
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