Provider Demographics
NPI:1376759001
Name:BETTINARDI, JAMIE LEANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEANN
Last Name:BETTINARDI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LEANN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1055 APPLEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CENTERTON
Mailing Address - State:AR
Mailing Address - Zip Code:72719-8953
Mailing Address - Country:US
Mailing Address - Phone:479-957-3254
Mailing Address - Fax:
Practice Address - Street 1:1055 APPLEWOOD CIR
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-8953
Practice Address - Country:US
Practice Address - Phone:479-957-3254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150264721Medicaid