Provider Demographics
NPI:1063539880
Name:HOWARD, CORKIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORKIE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5416
Mailing Address - Country:US
Mailing Address - Phone:479-462-3555
Mailing Address - Fax:
Practice Address - Street 1:476490 E 1060 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-5159
Practice Address - Country:US
Practice Address - Phone:479-462-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161556721Medicaid
OK5956OtherOKLAHOMA LICENSES
OK200344620AMedicaid
AR2464OtherARKANSAS LICENSE