Provider Demographics
NPI:1558816207
Name:HINKLE, JENNA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HINKLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 COBB PKWY NW
Mailing Address - Street 2:SUITE 801
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9532
Mailing Address - Country:US
Mailing Address - Phone:770-917-5737
Mailing Address - Fax:770-917-5740
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 801
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:770-917-5737
Practice Address - Fax:770-917-5740
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009396235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP009396OtherSTATE OF GEORGIA LICENCE SLP009396