Provider Demographics
NPI:1235846973
Name:NEWBOLD, DESTINY D (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DESTINY
Middle Name:D
Last Name:NEWBOLD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-5641
Mailing Address - Country:US
Mailing Address - Phone:479-459-9640
Mailing Address - Fax:
Practice Address - Street 1:44 BRADFORD DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72227-5641
Practice Address - Country:US
Practice Address - Phone:479-459-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120401235Z00000X
AR202819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120085901Medicaid