1962080630 NPI number — INNOVATIVE MEDICAL SPEECH LANGUAGE PATHOLOGY AND REHAB SERVICES, INC.

Table of content: (NPI 1962080630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962080630 NPI number — INNOVATIVE MEDICAL SPEECH LANGUAGE PATHOLOGY AND REHAB SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INNOVATIVE MEDICAL SPEECH LANGUAGE PATHOLOGY AND REHAB SERVICES, INC.
Provider Last Name:
Provider First Name:
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Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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NPI Number Information

NPI Number:
1962080630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
557 W SCHOOL ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLAND
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72417-8942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
557 W SCHOOL ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLAND
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72417-8942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-497-0326
Provider Business Practice Location Address Fax Number:
870-935-7809
Provider Enumeration Date:
04/01/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SHELBY
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
LEAD THERAPIST, ADMINISTRATOR
Authorized Official Telephone Number:
501-291-7222

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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