Provider Demographics
NPI:1699788927
Name:LIDE, MERCEDES COLLEEN (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:COLLEEN
Last Name:LIDE
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:COLLEEN
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-1085
Mailing Address - Fax:
Practice Address - Street 1:4300 WEST 7TH STREET
Practice Address - Street 2:CENTRAL ARKANSAS VETERANS HEALTHCARE SYSTEM
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-257-1085
Practice Address - Fax:501-257-1086
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA#157231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist