Provider Demographics
NPI:1336312859
Name:VINES, SHAYLIE CAPRI (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAYLIE
Middle Name:CAPRI
Last Name:VINES
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 GREENE 601
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7801
Mailing Address - Country:US
Mailing Address - Phone:870-335-5313
Mailing Address - Fax:
Practice Address - Street 1:107 N ROCKINGCHAIR RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2414
Practice Address - Country:US
Practice Address - Phone:870-897-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist