Ivy, Mattie

Ivy, Mattie is an individual health care provider with primary practice located at 724 Park St , Forrest City AR 72335-4823. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Ivy, Mattie can be contacted via phone (870) 633-4366.

Contact Information

Primary practice address
724 Park St Forrest City AR 72335-4823
Fax: (870) 792-7371
Website:

Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SP 822 Arkansas

Profile Details

NPI number 1689882995
LBN Legal business name Ivy, Mattie
Credentials SLP
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689882995 NPPES
Arkansas MEDICAID 127746721

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