Provider Demographics
NPI:1528780442
Name:FREPPON, MICA (BS SLPA)
Entity type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:FREPPON
Suffix:
Gender:F
Credentials:BS SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHERRYWOOD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-8447
Mailing Address - Country:US
Mailing Address - Phone:501-388-6460
Mailing Address - Fax:
Practice Address - Street 1:1400 HIGH SCHOOL DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2203
Practice Address - Country:US
Practice Address - Phone:870-234-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2020252355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant