| Organization Name: | ARKANSAS THERAPY SOURCE, LLC |
| NPI Number: | 1063674570 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER CHRISTY ROGERS (OWENER) |
| Mailing Address: | 116 Valderrama Dr Benton |
| State: | AR US |
| Postal Code: | 720158971 |
| Phone Number: | 5012498649 |
| Fax Number: | 5013150847 |
| NPI Enumeration Date: | 06/26/2008 |
| NPI Last Update Date: | 06/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SP2309 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |