Individual
MRS. MOLLIE GENTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP ROAD, WARD, AR 72176
(501) 941-5630
Mailing address
PO BOX 333, WARD, AR 72176-0333
(501) 912-1352
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2360
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y680
BLUE CROSS & BLUE SHIELD
AR
Enumeration date
01/26/2007
Last updated
07/08/2007
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