Provider Demographics
NPI:1316490915
Name:RAGSDALE, LAERYN NICOLE
Entity type:Individual
Prefix:
First Name:LAERYN
Middle Name:NICOLE
Last Name:RAGSDALE
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 1:210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-3048
Mailing Address - Country:US
Mailing Address - Phone:501-882-3852
Mailing Address - Fax:501-882-2759
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-3048
Practice Address - Country:US
Practice Address - Phone:501-882-3852
Practice Address - Fax:501-882-2759
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9060235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist