Provider Demographics
NPI:1164658134
Name:JETER, MARCI (MS-CCC, SLP)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:JETER
Suffix:
Gender:F
Credentials:MS-CCC, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 WEIDNER ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-6438
Mailing Address - Country:US
Mailing Address - Phone:870-421-6266
Mailing Address - Fax:
Practice Address - Street 1:3920 WOODLAND HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-2495
Practice Address - Country:US
Practice Address - Phone:870-421-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist