Provider Demographics
NPI:1427838077
Name:DEESE, RUBY LOU JEWEL
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:LOU JEWEL
Last Name:DEESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10593 N WEDINGTON BLACKTOP RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE GROVE
Mailing Address - State:AR
Mailing Address - Zip Code:72753-9662
Mailing Address - Country:US
Mailing Address - Phone:479-305-4781
Mailing Address - Fax:
Practice Address - Street 1:3162 W M.L.K. JR. BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704
Practice Address - Country:US
Practice Address - Phone:479-435-6636
Practice Address - Fax:479-435-6654
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist