Provider Demographics
NPI:1598036030
Name:SPEECH WORKS, LLC
Entity type:Organization
Organization Name:SPEECH WORKS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-270-7963
Mailing Address - Street 1:5 COUNTY ROAD 7290
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-8121
Mailing Address - Country:US
Mailing Address - Phone:870-270-7963
Mailing Address - Fax:870-374-6061
Practice Address - Street 1:111 MERRIMAN AVE E
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-2941
Practice Address - Country:US
Practice Address - Phone:870-270-7963
Practice Address - Fax:870-697-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#3079235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR185789721Medicaid
AR163557721Medicaid