Provider Demographics
NPI:1154533032
Name:RADFORD, TABITHA (SLP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:RADFORD
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 1:4 N DOUBLE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2522
Mailing Address - Country:US
Mailing Address - Phone:479-267-5960
Mailing Address - Fax:479-267-5965
Practice Address - Street 1:4 N DOUBLE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2522
Practice Address - Country:US
Practice Address - Phone:479-267-5960
Practice Address - Fax:479-267-5965
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR160603721Medicaid