Provider Demographics
NPI:1508823063
Name:HINES, JANNA LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:LEIGH
Last Name:HINES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3717
Mailing Address - Country:US
Mailing Address - Phone:479-544-2734
Mailing Address - Fax:855-975-2995
Practice Address - Street 1:3104 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3717
Practice Address - Country:US
Practice Address - Phone:479-696-8819
Practice Address - Fax:501-542-4171
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
AR1837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152411721Medicaid
AR152411721Medicaid