Provider Demographics
NPI:1730919051
Name:OSBORNE, DESIRE NICOLE
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:NICOLE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 N SCHOOL ST APT A
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933-9461
Mailing Address - Country:US
Mailing Address - Phone:479-849-0121
Mailing Address - Fax:
Practice Address - Street 1:3010 HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:BRANCH
Practice Address - State:AR
Practice Address - Zip Code:72928-9648
Practice Address - Country:US
Practice Address - Phone:479-965-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202605235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist