Provider Demographics
NPI:1528100666
Name:PRINCE, DEANNA L (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:L
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4530
Mailing Address - Country:US
Mailing Address - Phone:501-230-9995
Mailing Address - Fax:
Practice Address - Street 1:221 LINDLEY LN
Practice Address - Street 2:UAMS-KIDS FIRST NEWPORT
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-4954
Practice Address - Country:US
Practice Address - Phone:870-523-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP #794235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123431721Medicaid