Bruce Oakley Polk Irico, Recovery Assistant
Case Manager/Care Coordinator in Benton, AR. Individual provider (NPI-1).
NPI number1295065613
StatusActive
Last updated in NPPESJan 7, 2010
Details
- NPI
- 1295065613
- Entity type
- Individual (NPI-1)
- Name
- Bruce Oakley Polk Irico
- Credential
- Recovery Assistant
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 7, 2010
- Last updated
- Jan 7, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171M00000X | Case Manager/Care Coordinator | – | AR | Yes |
Practice location
1502 Mary Kay BlvdBenton, AR 72015
Phone 501-315-3344
Mailing address
Po Box 1589Benton, AR 72018-1589
Phone 501-315-3344
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