Provider Demographics
NPI:1881999407
Name:WIBD--LITTLE ROCK, PLLC
Entity type:Organization
Organization Name:WIBD--LITTLE ROCK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-880-1515
Mailing Address - Street 1:1000 HIGHWAY 35 N STE 1
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-2353
Mailing Address - Country:US
Mailing Address - Phone:501-776-4343
Mailing Address - Fax:501-776-4347
Practice Address - Street 1:1000 HIGHWAY 35 N STE 1
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2353
Practice Address - Country:US
Practice Address - Phone:501-776-4343
Practice Address - Fax:501-776-4347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WERNER INSTITUTE OF BALANCE & DIZZINESS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty