Provider Demographics
NPI:1619108552
Name:STROUD, VIRGINIA ELLEN (SLP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ELLEN
Last Name:STROUD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2250 HEBER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8415
Mailing Address - Country:US
Mailing Address - Phone:918-640-4681
Mailing Address - Fax:
Practice Address - Street 1:2250 HEBER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-8415
Practice Address - Country:US
Practice Address - Phone:918-640-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist