Provider Demographics
NPI:1861641979
Name:PEARSALL, VALERIE (MED)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 STANNUS ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7067
Mailing Address - Country:US
Mailing Address - Phone:501-447-7236
Mailing Address - Fax:501-447-7201
Practice Address - Street 1:4015 STANNUS ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7067
Practice Address - Country:US
Practice Address - Phone:501-447-7236
Practice Address - Fax:501-447-7201
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR169500721Medicaid