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
Phone: (870) 633-4366
Fax: (870) 792-7371
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689882995 | NPPES |
| Arkansas | MEDICAID | 127746721 |
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