Provider Demographics
NPI:1801480652
Name:SPEECHWORKS THERAPY SERVICES LLC
Entity type:Organization
Organization Name:SPEECHWORKS THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GWENDDLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:870-761-1417
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432-0083
Mailing Address - Country:US
Mailing Address - Phone:870-761-1417
Mailing Address - Fax:
Practice Address - Street 1:1407 MARKETPLACE DR
Practice Address - Street 2:STE 1
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5227
Practice Address - Country:US
Practice Address - Phone:870-761-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty