Provider Demographics
NPI:1154697928
Name:UTLEY, FORREST DAYANNE (MCD, CCC -SLP)
Entity type:Individual
Prefix:MRS
First Name:FORREST
Middle Name:DAYANNE
Last Name:UTLEY
Suffix:
Gender:F
Credentials:MCD, CCC -SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 COUNTY ROAD 372
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8552
Mailing Address - Country:US
Mailing Address - Phone:870-238-6550
Mailing Address - Fax:
Practice Address - Street 1:390 COUNTY ROAD 372
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-8552
Practice Address - Country:US
Practice Address - Phone:870-238-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist