Provider Demographics
NPI:1104145523
Name:HUNTER, LILY M (SLP)
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:M
Last Name:HUNTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 HAIRSTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3227
Mailing Address - Country:US
Mailing Address - Phone:501-450-6634
Mailing Address - Fax:
Practice Address - Street 1:1805 OLD MILITARY RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-8654
Practice Address - Country:US
Practice Address - Phone:501-450-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist