Individual
NICOLE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
207 W CONWAY ST, BENTON, AR 72015-3727
(501) 778-4861
(501) 776-5794
Mailing address
5011 CONGRESSIONAL DR, BENTON, AR 72019-3455
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217821721
—
AR
Enumeration date
03/03/2017
Last updated
03/03/2017
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