Provider Demographics
NPI:1649738881
Name:HINCKLEY, JANET (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:HINCKLEY
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 1:5846 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9401
Mailing Address - Country:US
Mailing Address - Phone:269-932-8632
Mailing Address - Fax:
Practice Address - Street 1:5846 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9401
Practice Address - Country:US
Practice Address - Phone:269-932-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004474235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist