Provider Demographics
NPI:1205724143
Name:RATCLIFFE, MARY GRACE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:RATCLIFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 N DIXIELAND RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FLOCK
Mailing Address - State:AR
Mailing Address - Zip Code:72756-6817
Mailing Address - Country:US
Mailing Address - Phone:479-346-5459
Mailing Address - Fax:
Practice Address - Street 1:3415 N DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:LITTLE FLOCK
Practice Address - State:AR
Practice Address - Zip Code:72756-6817
Practice Address - Country:US
Practice Address - Phone:479-346-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR203192235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist