Provider Demographics
NPI:1508840943
Name:HAYES, JENNIFER E (SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:HAYES
Suffix:
Gender:F
Credentials:SLP CCC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 SWEETWATER RIM
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5691
Mailing Address - Country:US
Mailing Address - Phone:318-419-8176
Mailing Address - Fax:800-223-5022
Practice Address - Street 1:208 SWEETWATER RIM
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5691
Practice Address - Country:US
Practice Address - Phone:318-419-8176
Practice Address - Fax:800-223-5022
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4768235Z00000X
LAASHA 12059662235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1 06856 0Medicaid