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Individual

AMY LANETTE RUCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
314 LONGHORN DR., VIOLA, AR 72583-0380
(870) 458-2511
Mailing address
314 LONGHORN DR., VIOLA, AR 72583-0380
(870) 458-2511

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP1503
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
136543721
AR
Enumeration date
04/10/2008
Last updated
11/17/2010
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