Provider Demographics
NPI:1902135403
Name:BOSCHETTI, ELIZABETH K (MA,CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:K
Last Name:BOSCHETTI
Suffix:
Gender:F
Credentials:MA,CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4579
Mailing Address - Country:US
Mailing Address - Phone:501-231-0255
Mailing Address - Fax:
Practice Address - Street 1:17706 INTERSTATE 30
Practice Address - Street 2:SUITE 3
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2907
Practice Address - Country:US
Practice Address - Phone:501-315-4414
Practice Address - Fax:501-315-3467
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8288235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180463721Medicaid
ARSP#P8288OtherARKANSAS BOARD OF EXAMINERS SPEECH LANGUAGE PATHOLOGY AND AUDIOLOGY