Provider Demographics
NPI:1598165896
Name:STOVALL, LEIDA LYNDA IVETTE (AUD)
Entity type:Individual
Prefix:
First Name:LEIDA
Middle Name:LYNDA IVETTE
Last Name:STOVALL
Suffix:
Gender:
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2941
Mailing Address - Country:US
Mailing Address - Phone:870-424-4200
Mailing Address - Fax:870-424-4327
Practice Address - Street 1:626 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2941
Practice Address - Country:US
Practice Address - Phone:870-424-4200
Practice Address - Fax:870-424-4327
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014030455231H00000X
AR202579231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist