Provider Demographics
NPI:1285363747
Name:SAVATHVONGXAY, NAMTIP THEPOUTHAY
Entity type:Individual
Prefix:
First Name:NAMTIP
Middle Name:THEPOUTHAY
Last Name:SAVATHVONGXAY
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 1:2725 N 50TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72904-5049
Mailing Address - Country:US
Mailing Address - Phone:479-414-1573
Mailing Address - Fax:
Practice Address - Street 1:10310 W MARKHAM ST STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-1579
Practice Address - Country:US
Practice Address - Phone:501-406-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist