1821325358 NPI number — JESSICA LYNN WHITE M.S. CCC-SLP

Table of content: JESSICA LYNN WHITE M.S. CCC-SLP (NPI 1821325358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821325358 NPI number — JESSICA LYNN WHITE M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
JESSICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALLIGAN
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821325358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3811 N OLIVE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-8747
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:
401 N LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CABOT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72023-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-944-5350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP#P8259 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com