Provider Demographics
NPI:1386873156
Name:HAJISTATHI, CARMEN MICHELLE (BA SLPA)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:MICHELLE
Last Name:HAJISTATHI
Suffix:
Gender:F
Credentials:BA SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WOOD ACRES DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-2300
Mailing Address - Country:US
Mailing Address - Phone:870-310-1999
Mailing Address - Fax:
Practice Address - Street 1:191 WOOD ACRES DR
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-2300
Practice Address - Country:US
Practice Address - Phone:870-310-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant