Provider Demographics
NPI:1215198981
Name:HINCKLEY, JACQUELINE JAY (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JAY
Last Name:HINCKLEY
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 32ND ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-6631
Mailing Address - Country:US
Mailing Address - Phone:727-460-0671
Mailing Address - Fax:
Practice Address - Street 1:901 32ND ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-6631
Practice Address - Country:US
Practice Address - Phone:727-460-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist