Provider Demographics
NPI:1336369032
Name:ATCHERSON, SAMUEL RAY (PHD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RAY
Last Name:ATCHERSON
Suffix:
Gender:M
Credentials:PHD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1000
Mailing Address - Country:US
Mailing Address - Phone:501-569-3155
Mailing Address - Fax:501-569-3157
Practice Address - Street 1:2801 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1000
Practice Address - Country:US
Practice Address - Phone:501-569-3155
Practice Address - Fax:501-569-3157
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#303231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist