Individual
MRS. LELA SAMANTHA WHITESIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CFY-SLP
Contact information
Practice address
10618 BRECKENRIDGE DR, LITTLE ROCK, AR 72211-1802
(501) 217-8600
(501) 217-8636
Mailing address
10618 BRECKENRIDGE DR, LITTLE ROCK, AR 72211-1802
(501) 217-8600
(501) 217-8636
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP#P8707
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SP#P8707
ARKANSAS STATE LICENSE
AR
Enumeration date
09/11/2013
Last updated
09/16/2013
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