Provider Demographics
NPI:1598895146
Name:HINES, ELAINE L (MA,CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:L
Last Name:HINES
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 PEGRAM DR
Mailing Address - Street 2:P.O. BOX 2180
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6322
Mailing Address - Country:US
Mailing Address - Phone:662-844-3583
Mailing Address - Fax:662-840-8354
Practice Address - Street 1:618 PEGRAM DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6322
Practice Address - Country:US
Practice Address - Phone:662-844-3583
Practice Address - Fax:662-840-8354
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA0254231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSA0254OtherMS STATE BOARD OF HEALTH
MS00075029Medicaid
MS00739433OtherAM SPEECH LGG HEARING ASC