Provider Demographics
NPI:1114546876
Name:VINCENT, J HALEY LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:J HALEY
Middle Name:LYNN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:HALEY
Other - Last Name:LYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 JEFFERSON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4900
Mailing Address - Country:US
Mailing Address - Phone:901-287-4779
Mailing Address - Fax:901-287-4901
Practice Address - Street 1:600 JEFFERSON AVE FL 3
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4900
Practice Address - Country:US
Practice Address - Phone:901-287-4779
Practice Address - Fax:901-287-4901
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist